|
GENTAMICIN SULFATE 10 MG/ML IJ SOLN [3425]
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63323017301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$2.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.21
|
| Rate for Payer: Group Health Inc Commercial |
$1.62
|
| Rate for Payer: Group Health Inc Medicare |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.11
|
|
|
GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63323001003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$1.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63323001001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$1.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.66
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63323001094
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63323001020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$1.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]
|
Facility
|
OP
|
$2.44
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63323001002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.68
|
| Rate for Payer: Aetna Government |
$1.68
|
| Rate for Payer: Brighton Health Commercial |
$1.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.66
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
GENTAMICIN TROUGH
|
Facility
|
OP
|
$40.95
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
40602580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.38
|
| Rate for Payer: Aetna Government |
$16.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.47
|
| Rate for Payer: Brighton Health Commercial |
$30.71
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Cash Price |
$16.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.38
|
| Rate for Payer: EmblemHealth Commercial |
$16.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.58
|
| Rate for Payer: Group Health Inc Commercial |
$16.38
|
| Rate for Payer: Group Health Inc Medicare |
$16.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.38
|
| Rate for Payer: Healthfirst QHP |
$16.38
|
| Rate for Payer: Humana Medicare |
$16.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.38
|
| Rate for Payer: United Healthcare Commercial |
$20.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.10
|
| Rate for Payer: Wellcare Medicare |
$14.74
|
|
|
GENTAMICIN TROUGH
|
Facility
|
IP
|
$40.95
|
|
|
Service Code
|
HCPCS 80170
|
| Hospital Charge Code |
40602580
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$16.38
|
|
|
GENTIAN VIOLET 1 % EX SOLN [3430]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 00395100392
|
| Hospital Charge Code |
00395100392
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
GENTIAN VIOLET SOLUTION
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
41641671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$5.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
GENTIAN VIOLET SOLUTION
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
41651671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$5.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
GEN TROCAR PIN 1/8 X 3
|
Facility
|
OP
|
$57.30
|
|
| Hospital Charge Code |
64906075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$45.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.65
|
| Rate for Payer: Aetna Government |
$28.65
|
| Rate for Payer: Brighton Health Commercial |
$42.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.96
|
| Rate for Payer: Group Health Inc Commercial |
$28.65
|
| Rate for Payer: Group Health Inc Medicare |
$20.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.65
|
|
|
Geo Mattress
|
Facility
|
OP
|
$315.04
|
|
| Hospital Charge Code |
40201950
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.26 |
| Max. Negotiated Rate |
$252.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.52
|
| Rate for Payer: Aetna Government |
$157.52
|
| Rate for Payer: Brighton Health Commercial |
$236.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$252.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$214.23
|
| Rate for Payer: Group Health Inc Commercial |
$157.52
|
| Rate for Payer: Group Health Inc Medicare |
$110.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.52
|
|
|
GESTATIONAL GLUCOSE TOLERANCE 3HR
|
Facility
|
OP
|
$32.18
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
40602661
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.87
|
| Rate for Payer: Aetna Government |
$12.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.01
|
| Rate for Payer: Brighton Health Commercial |
$24.14
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.87
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.87
|
| Rate for Payer: Group Health Inc Medicare |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$12.87
|
| Rate for Payer: Humana Medicare |
$13.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$16.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
|
|
GESTATIONAL GLUCOSE TOLERANCE 3HR
|
Facility
|
IP
|
$32.18
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
40602661
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$12.87
|
|
|
GEST. GLUCOSE CHALLENGE TEST
|
Facility
|
IP
|
$32.18
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
40602686
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$12.87
|
|
|
GEST. GLUCOSE CHALLENGE TEST
|
Facility
|
OP
|
$32.18
|
|
|
Service Code
|
HCPCS 82951
|
| Hospital Charge Code |
40602686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.87
|
| Rate for Payer: Aetna Government |
$12.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.01
|
| Rate for Payer: Brighton Health Commercial |
$24.14
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.87
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.87
|
| Rate for Payer: Group Health Inc Medicare |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$12.87
|
| Rate for Payer: Humana Medicare |
$13.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$16.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
|
|
GIARDIA AG, EIA, STOOL
|
Facility
|
OP
|
$29.95
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
30303382
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$22.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.98
|
| Rate for Payer: Aetna Government |
$11.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.39
|
| Rate for Payer: Brighton Health Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.98
|
| Rate for Payer: EmblemHealth Commercial |
$11.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.98
|
| Rate for Payer: Healthfirst QHP |
$11.98
|
| Rate for Payer: Humana Medicare |
$12.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.58
|
| Rate for Payer: Wellcare Medicare |
$10.78
|
|
|
GIARDIA AG, EIA, STOOL
|
Facility
|
IP
|
$29.95
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
30303382
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$11.98
|
|
|
GIARDIA IAMBLIA AG, EIA
|
Facility
|
OP
|
$29.95
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
40619194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$22.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.98
|
| Rate for Payer: Aetna Government |
$11.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.39
|
| Rate for Payer: Brighton Health Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.98
|
| Rate for Payer: EmblemHealth Commercial |
$11.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.98
|
| Rate for Payer: Healthfirst QHP |
$11.98
|
| Rate for Payer: Humana Medicare |
$12.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.58
|
| Rate for Payer: Wellcare Medicare |
$10.78
|
|
|
GIARDIA IAMBLIA AG, EIA
|
Facility
|
IP
|
$29.95
|
|
|
Service Code
|
HCPCS 87329
|
| Hospital Charge Code |
40619194
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$11.98
|
|
|
GII PS HI FLEX ISRT SZ 3-4 11MM
|
Facility
|
OP
|
$2,948.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,095.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,621.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,768.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,474.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,695.17
|
| Rate for Payer: EmblemHealth Commercial |
$1,474.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,095.54
|
| Rate for Payer: Group Health Inc Commercial |
$1,474.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,031.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,474.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,474.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,916.28
|
|
|
GII PS HI FLEX ISRT SZ 3-4 11MM
|
Facility
|
IP
|
$2,948.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.06 |
| Max. Negotiated Rate |
$1,474.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,474.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,474.06
|
|
|
GII PS INSERT SZ 3-4 9MM
|
Facility
|
IP
|
$2,736.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,368.06 |
| Max. Negotiated Rate |
$1,368.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,368.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,368.06
|
|
|
GII PS INSERT SZ 3-4 9MM
|
Facility
|
OP
|
$2,736.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,872.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,504.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,641.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,368.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,573.27
|
| Rate for Payer: EmblemHealth Commercial |
$1,368.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,872.94
|
| Rate for Payer: Group Health Inc Commercial |
$1,368.06
|
| Rate for Payer: Group Health Inc Medicare |
$957.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,368.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,368.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,778.48
|
|
