|
ALTEPLASE 2 MG INJ
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
41642714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.50 |
| Max. Negotiated Rate |
$119.50 |
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.50
|
|
|
ALTEPLASE 50 MG INJ
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
41642080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.18 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$131.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$88.97
|
| Rate for Payer: Aetna Government |
$88.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.78
|
| Rate for Payer: Amida Care Medicaid |
$73.78
|
| Rate for Payer: Brighton Health Commercial |
$143.40
|
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$137.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$88.97
|
| Rate for Payer: EmblemHealth Commercial |
$88.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,378.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.47
|
| Rate for Payer: Group Health Inc Commercial |
$88.97
|
| Rate for Payer: Group Health Inc Medicare |
$88.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.78
|
| Rate for Payer: Healthfirst Essential Plan |
$166.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.63
|
| Rate for Payer: Healthfirst QHP |
$73.78
|
| Rate for Payer: Humana Medicare |
$90.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.78
|
| Rate for Payer: SOMOS Essential |
$73.78
|
| Rate for Payer: United Healthcare Commercial |
$88.03
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$166.00
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$81.16
|
| Rate for Payer: United Healthcare Medicaid |
$73.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$71.18
|
| Rate for Payer: Wellcare Medicare |
$84.53
|
|
|
ALTEPLASE 50 MG INJ
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
41642080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.50 |
| Max. Negotiated Rate |
$119.50 |
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.50
|
|
|
ALTEPLASE 50 MG INJ
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
41652080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.50 |
| Max. Negotiated Rate |
$119.50 |
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.50
|
|
|
ALTEPLASE 50 MG INJ
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
41652080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.18 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$131.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$88.97
|
| Rate for Payer: Aetna Government |
$88.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.78
|
| Rate for Payer: Amida Care Medicaid |
$73.78
|
| Rate for Payer: Brighton Health Commercial |
$143.40
|
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Cash Price |
$88.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$137.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$88.97
|
| Rate for Payer: EmblemHealth Commercial |
$88.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,378.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.47
|
| Rate for Payer: Group Health Inc Commercial |
$88.97
|
| Rate for Payer: Group Health Inc Medicare |
$88.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.78
|
| Rate for Payer: Healthfirst Essential Plan |
$166.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.63
|
| Rate for Payer: Healthfirst QHP |
$73.78
|
| Rate for Payer: Humana Medicare |
$90.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.78
|
| Rate for Payer: SOMOS Essential |
$73.78
|
| Rate for Payer: United Healthcare Commercial |
$88.03
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$166.00
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$81.16
|
| Rate for Payer: United Healthcare Medicaid |
$73.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$71.18
|
| Rate for Payer: Wellcare Medicare |
$84.53
|
|
|
ALTEPLASE 50 MG IV SOLR [9003]
|
Facility
|
OP
|
$5,280.22
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
50242004413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$71.18 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,904.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$88.97
|
| Rate for Payer: Aetna Government |
$88.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.78
|
| Rate for Payer: Amida Care Medicaid |
$73.78
|
| Rate for Payer: Brighton Health Commercial |
$3,168.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,640.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,036.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$88.97
|
| Rate for Payer: EmblemHealth Commercial |
$2,640.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,378.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.47
|
| Rate for Payer: Group Health Inc Commercial |
$88.97
|
| Rate for Payer: Group Health Inc Medicare |
$88.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,640.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.78
|
| Rate for Payer: Healthfirst Essential Plan |
$166.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.63
|
| Rate for Payer: Healthfirst QHP |
$73.78
|
| Rate for Payer: Humana Medicare |
$90.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.78
|
| Rate for Payer: SOMOS Essential |
$73.78
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$166.00
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$81.16
|
| Rate for Payer: United Healthcare Medicaid |
$73.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,432.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$71.18
|
|
|
ALTEPLASE 50 MG IV SOLR [9003]
|
Facility
|
IP
|
$5,280.22
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
50242004413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.11 |
| Max. Negotiated Rate |
$2,640.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,640.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,640.11
|
|
|
ALTRX 4 10D 36IDX52OD
|
Facility
|
OP
|
$8,022.50
|
|
| Hospital Charge Code |
64906071
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,807.88 |
| Max. Negotiated Rate |
$6,418.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,412.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,011.25
|
| Rate for Payer: Aetna Government |
$4,011.25
|
| Rate for Payer: Brighton Health Commercial |
$6,016.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,418.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,455.30
|
| Rate for Payer: Group Health Inc Commercial |
$4,011.25
|
| Rate for Payer: Group Health Inc Medicare |
$2,807.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,011.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,011.25
|
|
|
ALTRX 4 10D 36IDX52OD
|
Facility
|
OP
|
$6,418.00
|
|
| Hospital Charge Code |
40005154
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2,246.30 |
| Max. Negotiated Rate |
$5,134.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,529.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,209.00
|
| Rate for Payer: Aetna Government |
$3,209.00
|
| Rate for Payer: Brighton Health Commercial |
$4,813.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,134.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,364.24
|
| Rate for Payer: Group Health Inc Commercial |
$3,209.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,246.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,209.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,209.00
|
|
|
ALUMINA C-TAPE HEAD
|
Facility
|
OP
|
$3,596.00
|
|
| Hospital Charge Code |
40200569
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,258.60 |
| Max. Negotiated Rate |
$2,876.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,977.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,798.00
|
| Rate for Payer: Aetna Government |
$1,798.00
|
| Rate for Payer: Brighton Health Commercial |
$2,697.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,876.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,445.28
|
| Rate for Payer: Group Health Inc Commercial |
$1,798.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,258.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,798.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,798.00
|
|
|
ALUMINA C-TAPER HEAD
|
Facility
|
OP
|
$3,596.00
|
|
| Hospital Charge Code |
40200351
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,258.60 |
| Max. Negotiated Rate |
$2,876.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,977.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,798.00
|
| Rate for Payer: Aetna Government |
$1,798.00
|
| Rate for Payer: Brighton Health Commercial |
$2,697.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,876.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,445.28
|
| Rate for Payer: Group Health Inc Commercial |
$1,798.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,258.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,798.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,798.00
|
|
|
ALUMINA INSERT
|
Facility
|
OP
|
$3,229.80
|
|
| Hospital Charge Code |
40200354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,130.43 |
| Max. Negotiated Rate |
$2,583.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,776.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,614.90
|
| Rate for Payer: Aetna Government |
$1,614.90
|
| Rate for Payer: Brighton Health Commercial |
$2,422.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,583.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,196.26
|
| Rate for Payer: Group Health Inc Commercial |
$1,614.90
|
| Rate for Payer: Group Health Inc Medicare |
$1,130.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,614.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,614.90
|
|
|
ALUMINUM BLOOD
|
Facility
|
IP
|
$63.70
|
|
|
Service Code
|
HCPCS 82108
|
| Hospital Charge Code |
40607069
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$25.48
|
|
|
ALUMINUM BLOOD
|
Facility
|
OP
|
$63.70
|
|
|
Service Code
|
HCPCS 82108
|
| Hospital Charge Code |
40607069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$47.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.48
|
| Rate for Payer: Aetna Government |
$25.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.84
|
| Rate for Payer: Brighton Health Commercial |
$47.78
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.48
|
| Rate for Payer: EmblemHealth Commercial |
$25.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.68
|
| Rate for Payer: Group Health Inc Commercial |
$25.48
|
| Rate for Payer: Group Health Inc Medicare |
$25.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.48
|
| Rate for Payer: Healthfirst QHP |
$25.48
|
| Rate for Payer: Humana Medicare |
$25.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.48
|
| Rate for Payer: United Healthcare Commercial |
$32.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.38
|
| Rate for Payer: Wellcare Medicare |
$22.93
|
|
|
ALUMINUM CHLORIDE 20% 60ML TOP
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
41648006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
ALUMINUM CHLORIDE 20% 60ML TOP
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
41658006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
ALUMINUM CHLORIDE 20 % EX SOLN [9028]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 00096070735
|
| Hospital Charge Code |
00096070735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
ALUMINUM CHLORIDE 20 % EX SOLN [9028]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 00096070760
|
| Hospital Charge Code |
00096070760
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
ALUMINUM HYDROXIDE 1920 MG/30 ML SUSP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41643374
|
|
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
|
|
|
ALUMINUM HYDROXIDE 1920 MG/30 ML SUSP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41653374
|
|
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
|
|
|
ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP [353]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 00536009185
|
| Hospital Charge Code |
00536009185
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP [353]
|
Facility
|
OP
|
$0.09
|
|
|
Service Code
|
NDC 17856009103
|
| Hospital Charge Code |
17856009103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
ALUMINUM HYDROX + MAG HYDROX + SIMETHICO
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41654453
|
|
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
|
|
|
ALUMINUM HYDROX + MAG HYDROX + SIMETHICO
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41644453
|
|
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
|
|
|
ALUMINUM, PLASMA/SERUM
|
Facility
|
OP
|
$63.70
|
|
|
Service Code
|
HCPCS 82108
|
| Hospital Charge Code |
40609041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$47.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.48
|
| Rate for Payer: Aetna Government |
$25.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.84
|
| Rate for Payer: Brighton Health Commercial |
$47.78
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Cash Price |
$25.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.48
|
| Rate for Payer: EmblemHealth Commercial |
$25.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.68
|
| Rate for Payer: Group Health Inc Commercial |
$25.48
|
| Rate for Payer: Group Health Inc Medicare |
$25.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.48
|
| Rate for Payer: Healthfirst QHP |
$25.48
|
| Rate for Payer: Humana Medicare |
$25.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.48
|
| Rate for Payer: United Healthcare Commercial |
$32.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.38
|
| Rate for Payer: Wellcare Medicare |
$22.93
|
|
