|
GLIPIZIDE 5 MG PO TABS [10117]
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
NDC 00904663761
|
| Hospital Charge Code |
00904663761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.26
|
|
|
GLIPIZIDE 5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650530
|
|
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
|
|
|
GLIPIZIDE 5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640530
|
|
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
|
|
|
GLOBAL ADV ECCENT 48X18 HEAD
|
Facility
|
IP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.00 |
| Max. Negotiated Rate |
$1,555.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,555.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,555.00
|
|
|
GLOBAL ADV ECCENT 48X18 HEAD
|
Facility
|
OP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200943
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,265.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,710.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,866.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,555.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,788.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,555.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,265.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,555.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,088.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,555.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,555.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,021.50
|
|
|
GLOMERULAR BASEMENT MEMBRANE AB
|
Facility
|
IP
|
$36.38
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
40728014
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$14.55
|
|
|
GLOMERULAR BASEMENT MEMBRANE AB
|
Facility
|
OP
|
$36.38
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
40728014
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.55
|
| Rate for Payer: Aetna Government |
$14.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.18
|
| Rate for Payer: Brighton Health Commercial |
$27.28
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$14.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.95
|
| Rate for Payer: Group Health Inc Commercial |
$14.55
|
| Rate for Payer: Group Health Inc Medicare |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.55
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: Humana Medicare |
$14.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$18.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$13.10
|
|
|
GLOVE EXAM P/F LATEXLG.NONSTERILE
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
40209477
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| 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
|
|
|
GLOVE EXAM P/FLATEXMED NONSTERILE
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
40209476
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| 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
|
|
|
GLOVE EXAM VINYL MEDIUM
|
Facility
|
OP
|
$0.10
|
|
| Hospital Charge Code |
40209473
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
|
|
GLOVES
|
Facility
|
OP
|
$6.73
|
|
| Hospital Charge Code |
40202260
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Brighton Health Commercial |
$5.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
|
GLOVES LTEX LG.W/SHORT CUFF
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
40209478
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| 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
|
|
|
GLOVE SURGEON SZ 7 STERILE
|
Facility
|
OP
|
$0.62
|
|
| Hospital Charge Code |
40209471
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.31
|
| Rate for Payer: Aetna Government |
$0.31
|
| Rate for Payer: Brighton Health Commercial |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.42
|
| Rate for Payer: Group Health Inc Commercial |
$0.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.31
|
|
|
GLOVE SURG POLYISO ORTHO SZ 8
|
Facility
|
OP
|
$1.67
|
|
| Hospital Charge Code |
64906302
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
GLUCAGON 1 MG INJ
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
41643391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$309.00 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Cash Price |
$188.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.00
|
|
|
GLUCAGON 1 MG INJ
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
41643391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.86 |
| Max. Negotiated Rate |
$401.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$339.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.37
|
| Rate for Payer: Aetna Government |
$188.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$131.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$131.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$131.86
|
| Rate for Payer: Brighton Health Commercial |
$370.80
|
| Rate for Payer: Cash Price |
$188.37
|
| Rate for Payer: Cash Price |
$188.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$309.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$355.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$188.37
|
| Rate for Payer: EmblemHealth Commercial |
$188.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.79
|
| Rate for Payer: Group Health Inc Commercial |
$188.37
|
| Rate for Payer: Group Health Inc Medicare |
$188.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.11
|
| Rate for Payer: Healthfirst QHP |
$188.37
|
| Rate for Payer: Humana Medicare |
$192.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.01
|
| Rate for Payer: SOMOS Essential |
$203.01
|
| Rate for Payer: United Healthcare Commercial |
$173.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$150.69
|
| Rate for Payer: Wellcare Medicare |
$178.95
|
|
|
GLUCAGON 1 MG INJ
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
41653391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.86 |
| Max. Negotiated Rate |
$401.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$339.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.37
|
| Rate for Payer: Aetna Government |
$188.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$131.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$131.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$131.86
|
| Rate for Payer: Brighton Health Commercial |
$370.80
|
| Rate for Payer: Cash Price |
$188.37
|
| Rate for Payer: Cash Price |
$188.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$309.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$355.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$188.37
|
| Rate for Payer: EmblemHealth Commercial |
$188.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$197.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$197.79
|
| Rate for Payer: Group Health Inc Commercial |
$188.37
|
| Rate for Payer: Group Health Inc Medicare |
$188.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.11
|
| Rate for Payer: Healthfirst QHP |
$188.37
|
| Rate for Payer: Humana Medicare |
$192.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.01
|
| Rate for Payer: SOMOS Essential |
$203.01
|
| Rate for Payer: United Healthcare Commercial |
$173.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$150.69
|
| Rate for Payer: Wellcare Medicare |
$178.95
|
|
|
GLUCAGON 1 MG INJ
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
41653391
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$309.00 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Cash Price |
$188.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.00
|
|
|
GLUCAGON EMERGENCY 1 MG IJ KIT [38304]
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
00548585000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$131.86 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$184.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.37
|
| Rate for Payer: Aetna Government |
$188.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$131.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$131.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$131.86
|
| Rate for Payer: Brighton Health Commercial |
$252.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$268.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$228.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$188.37
|
| Rate for Payer: EmblemHealth Commercial |
$188.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.65
|
| Rate for Payer: Group Health Inc Commercial |
$188.37
|
| Rate for Payer: Group Health Inc Medicare |
$188.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.11
|
| Rate for Payer: Healthfirst QHP |
$188.37
|
| Rate for Payer: Humana Medicare |
$192.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$203.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$203.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$150.69
|
| Rate for Payer: Wellcare Medicare |
$178.95
|
|
|
GLUCAGON EMERGENCY 1 MG IJ KIT [38304]
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
50090655000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$131.86 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$184.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.37
|
| Rate for Payer: Aetna Government |
$188.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$131.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$131.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$131.86
|
| Rate for Payer: Brighton Health Commercial |
$252.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$188.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$268.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$228.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$188.37
|
| Rate for Payer: EmblemHealth Commercial |
$188.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$188.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.65
|
| Rate for Payer: Group Health Inc Commercial |
$188.37
|
| Rate for Payer: Group Health Inc Medicare |
$188.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.11
|
| Rate for Payer: Healthfirst QHP |
$188.37
|
| Rate for Payer: Humana Medicare |
$192.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$203.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$203.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$188.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$150.69
|
| Rate for Payer: Wellcare Medicare |
$178.95
|
|
|
GLUCAGON PLASMA
|
Facility
|
IP
|
$35.73
|
|
|
Service Code
|
HCPCS 82943
|
| Hospital Charge Code |
40609704
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$14.29
|
|
|
GLUCAGON PLASMA
|
Facility
|
OP
|
$35.73
|
|
|
Service Code
|
HCPCS 82943
|
| Hospital Charge Code |
40609704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$26.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.29
|
| Rate for Payer: Aetna Government |
$14.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.00
|
| Rate for Payer: Brighton Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.29
|
| Rate for Payer: EmblemHealth Commercial |
$14.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.72
|
| Rate for Payer: Group Health Inc Commercial |
$14.29
|
| Rate for Payer: Group Health Inc Medicare |
$14.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.29
|
| Rate for Payer: Healthfirst QHP |
$14.29
|
| Rate for Payer: Humana Medicare |
$14.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.29
|
| Rate for Payer: United Healthcare Commercial |
$18.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.43
|
| Rate for Payer: Wellcare Medicare |
$12.86
|
|
|
GLUCOCRUSH ORANGE 50G PLASTIC BTL
|
Facility
|
OP
|
$2.61
|
|
| Hospital Charge Code |
64901619
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.30
|
| Rate for Payer: Aetna Government |
$1.30
|
| Rate for Payer: Brighton Health Commercial |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.77
|
| Rate for Payer: Group Health Inc Commercial |
$1.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.30
|
|
|
GLUCOCRUSH ORANGE 75G PLASTIC BTL
|
Facility
|
OP
|
$0.44
|
|
| Hospital Charge Code |
64901617
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
|
|
GLUCOSE
|
Facility
|
IP
|
$9.83
|
|
|
Service Code
|
HCPCS 82947
|
| Hospital Charge Code |
40602085
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$3.93
|
|
