|
FERROUS SULFATE 300 MG/5 ML ELIXIR UDC
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640723
|
|
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
|
|
|
FERROUS SULFATE 300 MG/5 ML ELIXIR UDC
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650723
|
|
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
|
|
|
FERROUS SULFATE 300MG/6.8ML UD L
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41647032
|
|
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
|
|
|
FERROUS SULFATE 300MG/6.8ML UD L
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41657032
|
|
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
|
|
|
FERROUS SULFATE 325 (65 FE) MG PO TABS [3074]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
00904759161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
FERROUS SULFATE 325 (65 FE) MG PO TABS [3074]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 57896070310
|
| Hospital Charge Code |
57896070310
|
|
Hospital Revenue Code
|
250
|
| 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 |
$0.00
|
| 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
|
|
|
FERROUS SULFATE 325 (65 FE) MG PO TABS [3074]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 00536100901
|
| Hospital Charge Code |
00536100901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
FERROUS SULFATE 325 MG TAB
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
41653759
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FERROUS SULFATE 325 MG TAB
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
41643759
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN [95693]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 50383062750
|
| Hospital Charge Code |
50383062750
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN [95693]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 00087074002
|
| Hospital Charge Code |
00087074002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| 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 |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| 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 |
$0.14
|
|
|
FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN [95693]
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 54838001150
|
| Hospital Charge Code |
54838001150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
FETAL BLOOD KIT
|
Facility
|
OP
|
$38.27
|
|
| Hospital Charge Code |
40250100
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.14
|
| Rate for Payer: Aetna Government |
$19.14
|
| Rate for Payer: Brighton Health Commercial |
$28.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Group Health Inc Commercial |
$19.14
|
| Rate for Payer: Group Health Inc Medicare |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
|
|
FETAL CELL SCREEN
|
Facility
|
OP
|
$30.28
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
40701120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$22.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.11
|
| Rate for Payer: Aetna Government |
$12.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.48
|
| Rate for Payer: Brighton Health Commercial |
$22.71
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.11
|
| Rate for Payer: EmblemHealth Commercial |
$12.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.78
|
| Rate for Payer: Group Health Inc Commercial |
$12.11
|
| Rate for Payer: Group Health Inc Medicare |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.11
|
| Rate for Payer: Healthfirst QHP |
$12.11
|
| Rate for Payer: Humana Medicare |
$12.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare Commercial |
$15.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.69
|
| Rate for Payer: Wellcare Medicare |
$10.90
|
|
|
FETAL CELL SCREEN
|
Facility
|
IP
|
$30.28
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
40701120
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.11
|
|
|
FETAL CELL STAIN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 83033
|
| Hospital Charge Code |
40701125
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$8.00
|
|
|
FETAL CELL STAIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 83033
|
| Hospital Charge Code |
40701125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.60
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.00
|
| Rate for Payer: EmblemHealth Commercial |
$8.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.12
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.00
|
| Rate for Payer: Healthfirst QHP |
$8.00
|
| Rate for Payer: Humana Medicare |
$8.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.00
|
| Rate for Payer: United Healthcare Commercial |
$7.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.40
|
| Rate for Payer: Wellcare Medicare |
$7.20
|
|
|
FETAL CELL STAIN.
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 83033
|
| Hospital Charge Code |
40621551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.60
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.00
|
| Rate for Payer: EmblemHealth Commercial |
$8.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.12
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.00
|
| Rate for Payer: Healthfirst QHP |
$8.00
|
| Rate for Payer: Humana Medicare |
$8.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.00
|
| Rate for Payer: United Healthcare Commercial |
$7.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.40
|
| Rate for Payer: Wellcare Medicare |
$7.20
|
|
|
FETAL CELL STAIN.
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS 83033
|
| Hospital Charge Code |
40621551
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$8.00
|
|
|
FETAL ECHO
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76825 TC
|
| Hospital Charge Code |
30301300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.58 |
| Max. Negotiated Rate |
$1,125.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,125.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$952.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$446.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$542.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$574.17
|
| Rate for Payer: Group Health Inc Medicare |
$574.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$637.97
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$449.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
FETAL ECHO
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76825 TC
|
| Hospital Charge Code |
30301300
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
FETAL FIBRONECTIN..
|
Facility
|
OP
|
$161.03
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
40602038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.09 |
| Max. Negotiated Rate |
$120.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.41
|
| Rate for Payer: Aetna Government |
$64.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45.09
|
| Rate for Payer: Brighton Health Commercial |
$120.77
|
| Rate for Payer: Cash Price |
$64.41
|
| Rate for Payer: Cash Price |
$64.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$64.41
|
| Rate for Payer: EmblemHealth Commercial |
$64.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.32
|
| Rate for Payer: Group Health Inc Commercial |
$64.41
|
| Rate for Payer: Group Health Inc Medicare |
$64.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.41
|
| Rate for Payer: Healthfirst QHP |
$64.41
|
| Rate for Payer: Humana Medicare |
$65.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.41
|
| Rate for Payer: United Healthcare Commercial |
$81.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$51.53
|
| Rate for Payer: Wellcare Medicare |
$57.97
|
|
|
FETAL FIBRONECTIN..
|
Facility
|
IP
|
$161.03
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
40602038
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$64.41
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
IP
|
$502.93
|
|
|
Service Code
|
HCPCS 59025 TC
|
| Hospital Charge Code |
30306632
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$230.44
|
|
|
FETAL NON-STRESS TEST
|
Facility
|
OP
|
$502.93
|
|
|
Service Code
|
HCPCS 59025 TC
|
| Hospital Charge Code |
30306632
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.31 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.44
|
| Rate for Payer: Aetna Government |
$230.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$161.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$161.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$161.31
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.44
|
| 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 |
$230.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.09
|
| 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 |
$251.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.87
|
| Rate for Payer: Healthfirst QHP |
$230.44
|
| Rate for Payer: Humana Medicare |
$235.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.44
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$184.35
|
| Rate for Payer: Wellcare Medicare |
$218.92
|
|
