|
Infusor Pump
|
Facility
|
OP
|
$85.76
|
|
| Hospital Charge Code |
40202700
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$68.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.88
|
| Rate for Payer: Aetna Government |
$42.88
|
| Rate for Payer: Brighton Health Commercial |
$64.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.32
|
| Rate for Payer: Group Health Inc Commercial |
$42.88
|
| Rate for Payer: Group Health Inc Medicare |
$30.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.88
|
|
|
INFUVITE ADULT IV INJ [119571]
|
Facility
|
OP
|
$1.61
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
54643564901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
| Rate for Payer: Aetna Government |
$0.80
|
| Rate for Payer: Brighton Health Commercial |
$0.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.92
|
| Rate for Payer: EmblemHealth Commercial |
$0.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.80
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.04
|
|
|
INFUVITE ADULT IV INJ [119571]
|
Facility
|
IP
|
$1.61
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
54643564901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.80
|
|
|
INFUVITE PEDIATRIC IV SOLN [134881]
|
Facility
|
IP
|
$5.02
|
|
|
Service Code
|
NDC 54643564601
|
| Hospital Charge Code |
54643564601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.51
|
|
|
INFUVITE PEDIATRIC IV SOLN [134881]
|
Facility
|
OP
|
$5.02
|
|
|
Service Code
|
NDC 54643564601
|
| Hospital Charge Code |
54643564601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$5.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.51
|
| Rate for Payer: Aetna Government |
$2.51
|
| Rate for Payer: Brighton Health Commercial |
$3.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.89
|
| Rate for Payer: EmblemHealth Commercial |
$2.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.27
|
| Rate for Payer: Group Health Inc Commercial |
$2.51
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.26
|
|
|
INGENIO DR IS-1 PACEMAKER
|
Facility
|
OP
|
$11,500.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
66574081
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$12,075.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,325.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Brighton Health Commercial |
$6,900.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,750.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,612.50
|
| Rate for Payer: EmblemHealth Commercial |
$5,750.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,075.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,750.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,025.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,750.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,475.00
|
|
|
INGEST CHALLENGE ADDL 60 MIN
|
Facility
|
OP
|
$343.18
|
|
|
Service Code
|
HCPCS 95079
|
| Hospital Charge Code |
30305751
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$274.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.84
|
| Rate for Payer: Aetna Government |
$56.84
|
| Rate for Payer: Brighton Health Commercial |
$257.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.36
|
| Rate for Payer: Group Health Inc Commercial |
$171.59
|
| Rate for Payer: Group Health Inc Medicare |
$120.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.59
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
IP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
30305750
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
30305750
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$1,103.10
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
INGESTION CHALLENGE TEST
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
30301415
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$433.87 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$1,103.10
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$735.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
INGESTION CHALLENGE TEST
|
Facility
|
IP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
30301415
|
|
Hospital Revenue Code
|
924
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$37,830.64
|
|
|
Service Code
|
MSDRG 351
|
| Min. Negotiated Rate |
$12,481.80 |
| Max. Negotiated Rate |
$37,830.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,462.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,513.19
|
| Rate for Payer: Aetna Government |
$27,513.19
|
| Rate for Payer: Brighton Health Commercial |
$21,106.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,063.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,136.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,743.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,137.53
|
| Rate for Payer: EmblemHealth Commercial |
$12,481.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,513.19
|
| Rate for Payer: Group Health Inc Commercial |
$27,513.19
|
| Rate for Payer: Group Health Inc Medicare |
$27,513.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,513.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,793.63
|
| Rate for Payer: Humana Medicare |
$37,830.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,513.19
|
| Rate for Payer: United Healthcare Commercial |
$28,947.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,513.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,513.19
|
| Rate for Payer: Wellcare Medicare |
$26,137.53
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$55,838.16
|
|
|
Service Code
|
MSDRG 350
|
| Min. Negotiated Rate |
$18,883.45 |
| Max. Negotiated Rate |
$55,838.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35,388.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40,609.57
|
| Rate for Payer: Aetna Government |
$40,609.57
|
| Rate for Payer: Brighton Health Commercial |
$34,800.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41,421.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41,445.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34,202.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$38,579.09
|
| Rate for Payer: EmblemHealth Commercial |
$20,580.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$40,609.57
|
| Rate for Payer: Group Health Inc Commercial |
$40,609.57
|
| Rate for Payer: Group Health Inc Medicare |
$40,609.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40,609.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,883.45
|
| Rate for Payer: Humana Medicare |
$55,838.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40,609.57
|
| Rate for Payer: United Healthcare Commercial |
$47,728.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40,609.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40,609.57
|
| Rate for Payer: Wellcare Medicare |
$38,579.09
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,221.80
|
|
|
Service Code
|
MSDRG 352
|
| Min. Negotiated Rate |
$9,509.68 |
| Max. Negotiated Rate |
$31,221.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,352.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,706.76
|
| Rate for Payer: Aetna Government |
$22,706.76
|
| Rate for Payer: Brighton Health Commercial |
$16,080.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,160.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,151.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,804.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,571.42
|
| Rate for Payer: EmblemHealth Commercial |
$9,509.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,706.76
|
| Rate for Payer: Group Health Inc Commercial |
$22,706.76
|
| Rate for Payer: Group Health Inc Medicare |
$22,706.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,706.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,558.64
|
| Rate for Payer: Humana Medicare |
$31,221.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,706.76
|
| Rate for Payer: United Healthcare Commercial |
$22,054.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,706.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,706.76
|
| Rate for Payer: Wellcare Medicare |
$21,571.42
|
|
|
INHERITEST SOCIETY GUIDED PANEL
|
Facility
|
OP
|
$6,121.40
|
|
|
Service Code
|
HCPCS 81200
|
| Hospital Charge Code |
40603015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.08 |
| Max. Negotiated Rate |
$4,897.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,366.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.25
|
| Rate for Payer: Aetna Government |
$47.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.08
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,897.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,162.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.25
|
| Rate for Payer: EmblemHealth Commercial |
$47.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.05
|
| Rate for Payer: Group Health Inc Commercial |
$47.25
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,060.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.25
|
| Rate for Payer: Healthfirst QHP |
$47.25
|
| Rate for Payer: Humana Medicare |
$48.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.80
|
| Rate for Payer: Wellcare Medicare |
$42.52
|
|
|
INHERITEST SOCIETY GUIDED PANEL
|
Facility
|
IP
|
$6,121.40
|
|
|
Service Code
|
HCPCS 81200
|
| Hospital Charge Code |
40603015
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$47.25
|
|
|
INHIBIN A
|
Facility
|
IP
|
$38.98
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
40608439
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$15.59
|
|
|
INHIBIN A
|
Facility
|
OP
|
$38.98
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
30305609
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.59
|
| Rate for Payer: Aetna Government |
$15.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.91
|
| Rate for Payer: Brighton Health Commercial |
$29.24
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.59
|
| Rate for Payer: EmblemHealth Commercial |
$15.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.88
|
| Rate for Payer: Group Health Inc Commercial |
$15.59
|
| Rate for Payer: Group Health Inc Medicare |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.59
|
| Rate for Payer: Healthfirst QHP |
$15.59
|
| Rate for Payer: Humana Medicare |
$15.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare Commercial |
$19.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.47
|
| Rate for Payer: Wellcare Medicare |
$14.03
|
|
|
INHIBIN A
|
Facility
|
IP
|
$38.98
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
30305609
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$15.59
|
|
|
INHIBIN A
|
Facility
|
OP
|
$38.98
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
40608439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.59
|
| Rate for Payer: Aetna Government |
$15.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.91
|
| Rate for Payer: Brighton Health Commercial |
$29.24
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.59
|
| Rate for Payer: EmblemHealth Commercial |
$15.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.88
|
| Rate for Payer: Group Health Inc Commercial |
$15.59
|
| Rate for Payer: Group Health Inc Medicare |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.59
|
| Rate for Payer: Healthfirst QHP |
$15.59
|
| Rate for Payer: Humana Medicare |
$15.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare Commercial |
$19.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.47
|
| Rate for Payer: Wellcare Medicare |
$14.03
|
|
|
INHIBIN A, ULTRASENSITIVE
|
Facility
|
OP
|
$38.98
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
40609146
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.59
|
| Rate for Payer: Aetna Government |
$15.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.91
|
| Rate for Payer: Brighton Health Commercial |
$29.24
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Cash Price |
$15.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.59
|
| Rate for Payer: EmblemHealth Commercial |
$15.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.88
|
| Rate for Payer: Group Health Inc Commercial |
$15.59
|
| Rate for Payer: Group Health Inc Medicare |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.59
|
| Rate for Payer: Healthfirst QHP |
$15.59
|
| Rate for Payer: Humana Medicare |
$15.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare Commercial |
$19.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.47
|
| Rate for Payer: Wellcare Medicare |
$14.03
|
|
|
INHIBIN A, ULTRASENSITIVE
|
Facility
|
IP
|
$38.98
|
|
|
Service Code
|
HCPCS 86336
|
| Hospital Charge Code |
40609146
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$15.59
|
|
|
INHIBIN_B
|
Facility
|
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609751
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.38
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.82
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
INHIBIN_B
|
Facility
|
IP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609751
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$17.27
|
|
|
INIT HOSP/BIRTH CTR CARE PER DAY
|
Facility
|
OP
|
$351.13
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
30305381
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.01 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$193.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$152.87
|
| Rate for Payer: Aetna Government |
$152.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$107.01
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.87
|
| 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 |
$152.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.05
|
| 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 |
$175.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.94
|
| Rate for Payer: Healthfirst QHP |
$152.87
|
| Rate for Payer: Humana Medicare |
$155.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.87
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$122.30
|
| Rate for Payer: Wellcare Medicare |
$145.23
|
|
