|
FUNCTNAL EVAL-INIT 30 MIN
|
Facility
|
OP
|
$116.13
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
41704100
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.87
|
| Rate for Payer: Aetna Government |
$20.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.88
|
| Rate for Payer: Amida Care Medicaid |
$47.88
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,788.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.27
|
| Rate for Payer: Group Health Inc Commercial |
$58.06
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Healthfirst Essential Plan |
$107.73
|
| Rate for Payer: Healthfirst QHP |
$47.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.88
|
| Rate for Payer: SOMOS Essential |
$107.73
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$107.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$52.67
|
| Rate for Payer: United Healthcare Medicaid |
$47.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$47.88
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
FUNGI IDENTIFICATION YEAST
|
Facility
|
OP
|
$25.80
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
40614320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Government |
$10.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.22
|
| Rate for Payer: Brighton Health Commercial |
$19.35
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.32
|
| Rate for Payer: EmblemHealth Commercial |
$10.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.18
|
| Rate for Payer: Group Health Inc Commercial |
$10.32
|
| Rate for Payer: Group Health Inc Medicare |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.32
|
| Rate for Payer: Healthfirst QHP |
$10.32
|
| Rate for Payer: Humana Medicare |
$10.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.26
|
| Rate for Payer: Wellcare Medicare |
$9.29
|
|
|
FUNGI IDENTIFICATION YEAST
|
Facility
|
IP
|
$25.80
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
40614320
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$10.32
|
|
|
FUNGITELL, SERUM
|
Facility
|
OP
|
$275.00
|
|
| Hospital Charge Code |
40601159
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$151.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$137.50
|
| Rate for Payer: Aetna Government |
$137.50
|
| Rate for Payer: Brighton Health Commercial |
$206.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$220.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.00
|
| Rate for Payer: Group Health Inc Commercial |
$137.50
|
| Rate for Payer: Group Health Inc Medicare |
$96.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.50
|
|
|
FUNGUS CULTURE - POSITIVE
|
Facility
|
OP
|
$25.80
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
40614025
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Government |
$10.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.22
|
| Rate for Payer: Brighton Health Commercial |
$19.35
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.32
|
| Rate for Payer: EmblemHealth Commercial |
$10.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.18
|
| Rate for Payer: Group Health Inc Commercial |
$10.32
|
| Rate for Payer: Group Health Inc Medicare |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.32
|
| Rate for Payer: Healthfirst QHP |
$10.32
|
| Rate for Payer: Humana Medicare |
$10.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.26
|
| Rate for Payer: Wellcare Medicare |
$9.29
|
|
|
FUNGUS CULTURE - POSITIVE
|
Facility
|
IP
|
$25.80
|
|
|
Service Code
|
HCPCS 87106
|
| Hospital Charge Code |
40614025
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$10.32
|
|
|
FUNGUS ISOLATION CULTURE
|
Facility
|
IP
|
$21.03
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
40614318
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$8.41
|
|
|
FUNGUS ISOLATION CULTURE
|
Facility
|
OP
|
$21.03
|
|
|
Service Code
|
HCPCS 87102
|
| Hospital Charge Code |
40614318
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.41
|
| Rate for Payer: Aetna Government |
$8.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.89
|
| Rate for Payer: Brighton Health Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.41
|
| Rate for Payer: EmblemHealth Commercial |
$8.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$8.41
|
| Rate for Payer: Group Health Inc Medicare |
$8.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.41
|
| Rate for Payer: Healthfirst QHP |
$8.41
|
| Rate for Payer: Humana Medicare |
$8.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare Commercial |
$10.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.73
|
| Rate for Payer: Wellcare Medicare |
$7.57
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.48
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
70860030204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
25021031110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
16729050143
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.64
|
| Rate for Payer: Group Health Inc Commercial |
$0.47
|
| Rate for Payer: Group Health Inc Medicare |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.61
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
63323028004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.94
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
36000028325
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.64
|
| Rate for Payer: Group Health Inc Commercial |
$0.47
|
| Rate for Payer: Group Health Inc Medicare |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.61
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
70860030210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| 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 |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
63323028003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
63323028002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.86
|
| Rate for Payer: Group Health Inc Commercial |
$0.63
|
| Rate for Payer: Group Health Inc Medicare |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.82
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
16729050243
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$1.43
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
16729050008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$1.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Group Health Inc Commercial |
$0.72
|
| Rate for Payer: Group Health Inc Medicare |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.93
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$1.26
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
63323028001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.86
|
| Rate for Payer: Group Health Inc Commercial |
$0.63
|
| Rate for Payer: Group Health Inc Medicare |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.82
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
36000028425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.24
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
63323028010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
FUROSEMIDE 10 MG/ML IJ SOLN [3291]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
63323028026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| 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 |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
FUROSEMIDE 10 MG/ML INJ 10 ML
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
41644477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
|
|
FUROSEMIDE 10 MG/ML INJ 10 ML
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
41654477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
|
|
FUROSEMIDE 10 MG/ML INJ 10 ML
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
41654477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.64
|
| Rate for Payer: SOMOS Essential |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
