|
HOLDER HEAD W/TRACH CUTOUT
|
Facility
|
OP
|
$8.23
|
|
| Hospital Charge Code |
64902124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$6.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.12
|
| Rate for Payer: Aetna Government |
$4.12
|
| Rate for Payer: Brighton Health Commercial |
$6.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.60
|
| Rate for Payer: Group Health Inc Commercial |
$4.12
|
| Rate for Payer: Group Health Inc Medicare |
$2.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.12
|
|
|
HOLDER NEEDLE HALSEY SMOOTH
|
Facility
|
OP
|
$277.42
|
|
| Hospital Charge Code |
40200453
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.10 |
| Max. Negotiated Rate |
$221.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$138.71
|
| Rate for Payer: Aetna Government |
$138.71
|
| Rate for Payer: Brighton Health Commercial |
$208.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$221.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$188.65
|
| Rate for Payer: Group Health Inc Commercial |
$138.71
|
| Rate for Payer: Group Health Inc Medicare |
$97.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.71
|
|
|
HOLDER NEEDLE HEANEY
|
Facility
|
OP
|
$267.72
|
|
| Hospital Charge Code |
40200454
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.70 |
| Max. Negotiated Rate |
$214.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$133.86
|
| Rate for Payer: Aetna Government |
$133.86
|
| Rate for Payer: Brighton Health Commercial |
$200.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$214.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.05
|
| Rate for Payer: Group Health Inc Commercial |
$133.86
|
| Rate for Payer: Group Health Inc Medicare |
$93.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.86
|
|
|
HOLE COVER REF THREADED
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$194.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$111.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$106.75
|
| Rate for Payer: EmblemHealth Commercial |
$92.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.93
|
| Rate for Payer: Group Health Inc Commercial |
$92.82
|
| Rate for Payer: Group Health Inc Medicare |
$64.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.67
|
|
|
HOLE COVER REF THREADED
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905213
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$92.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.82
|
|
|
HOLE COVER SCREW R3
|
Facility
|
OP
|
$78.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$47.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$45.14
|
| Rate for Payer: EmblemHealth Commercial |
$39.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.42
|
| Rate for Payer: Group Health Inc Commercial |
$39.25
|
| Rate for Payer: Group Health Inc Medicare |
$27.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.02
|
|
|
HOLE COVER SCREW R3
|
Facility
|
IP
|
$78.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.25
|
|
|
HOLE PRBITAL RIM PLATE MIDFACE
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.00
|
|
|
HOLE PRBITAL RIM PLATE MIDFACE
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$407.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$232.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$194.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$223.10
|
| Rate for Payer: EmblemHealth Commercial |
$194.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$407.40
|
| Rate for Payer: Group Health Inc Commercial |
$194.00
|
| Rate for Payer: Group Health Inc Medicare |
$135.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.20
|
|
|
HOLTER
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
40804100
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
HOLTER
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 93225
|
| Hospital Charge Code |
40804100
|
|
Hospital Revenue Code
|
731
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
HOLTER SCANNING
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
40804110
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
HOLTER SCANNING
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 93226
|
| Hospital Charge Code |
40804110
|
|
Hospital Revenue Code
|
731
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
HOMANN RETR BLD 22MM CVD
|
Facility
|
OP
|
$318.15
|
|
| Hospital Charge Code |
64905637
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$254.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$159.08
|
| Rate for Payer: Aetna Government |
$159.08
|
| Rate for Payer: Brighton Health Commercial |
$238.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$254.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$216.34
|
| Rate for Payer: Group Health Inc Commercial |
$159.08
|
| Rate for Payer: Group Health Inc Medicare |
$111.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$159.08
|
|
|
HOMATROPINE 5 % OPHTHALMIC SOLUTION
|
Facility
|
OP
|
$30.48
|
|
| Hospital Charge Code |
41652300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.24
|
| Rate for Payer: Aetna Government |
$15.24
|
| Rate for Payer: Brighton Health Commercial |
$22.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.73
|
| Rate for Payer: Group Health Inc Commercial |
$15.24
|
| Rate for Payer: Group Health Inc Medicare |
$10.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.81
|
|
|
HOMATROPINE 5 % OPHTHALMIC SOLUTION
|
Facility
|
OP
|
$30.48
|
|
| Hospital Charge Code |
41642300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.24
|
| Rate for Payer: Aetna Government |
$15.24
|
| Rate for Payer: Brighton Health Commercial |
$22.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.73
|
| Rate for Payer: Group Health Inc Commercial |
$15.24
|
| Rate for Payer: Group Health Inc Medicare |
$10.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.81
|
|
|
HOME HEALTH CERTIFICATION
|
Facility
|
OP
|
$109.60
|
|
|
Service Code
|
HCPCS G0180
|
| Hospital Charge Code |
30301560
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.56 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.56
|
| Rate for Payer: Aetna Government |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$54.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.80
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HOME SLEEP TEST/TYPE 2 PORTA
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS G0398 TC
|
| Hospital Charge Code |
30305447
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
HOME SLEEP TEST/TYPE 2 PORTA
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS G0398 TC
|
| Hospital Charge Code |
30305447
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| 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 |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
HOME SUPPLY INJECT NALOXON
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2216
|
| Hospital Charge Code |
30300344
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| 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: United Healthcare Commercial |
$94.00
|
|
|
HOME SUPPLY NASAL NALOXONE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2215
|
| Hospital Charge Code |
30300343
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| 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: United Healthcare Commercial |
$94.00
|
|
|
HOMOCYSTEINE CARDIOVASCULAR
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
30303371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.92
|
| Rate for Payer: Aetna Government |
$17.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.54
|
| Rate for Payer: Brighton Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.92
|
| Rate for Payer: EmblemHealth Commercial |
$17.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.95
|
| Rate for Payer: Group Health Inc Commercial |
$17.92
|
| Rate for Payer: Group Health Inc Medicare |
$17.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.92
|
| Rate for Payer: Healthfirst QHP |
$17.92
|
| Rate for Payer: Humana Medicare |
$18.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.92
|
| Rate for Payer: United Healthcare Commercial |
$21.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Wellcare Medicare |
$16.13
|
|
|
HOMOCYSTEINE CARDIOVASCULAR
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
30303371
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$17.92
|
|
|
HOMOCYST(S)INE, PLASMA
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
40609084
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$17.92
|
|
|
HOMOCYST(S)INE, PLASMA
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
40609084
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.92
|
| Rate for Payer: Aetna Government |
$17.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.54
|
| Rate for Payer: Brighton Health Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.92
|
| Rate for Payer: EmblemHealth Commercial |
$17.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.95
|
| Rate for Payer: Group Health Inc Commercial |
$17.92
|
| Rate for Payer: Group Health Inc Medicare |
$17.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.92
|
| Rate for Payer: Healthfirst QHP |
$17.92
|
| Rate for Payer: Humana Medicare |
$18.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.92
|
| Rate for Payer: United Healthcare Commercial |
$21.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Wellcare Medicare |
$16.13
|
|
