|
INJ PERTUZUMAB, 10MG
|
Facility
|
OP
|
$19.06
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
41647791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.43
|
| Rate for Payer: Aetna Government |
$15.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.32
|
| Rate for Payer: Amida Care Medicaid |
$10.32
|
| Rate for Payer: Brighton Health Commercial |
$11.44
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.43
|
| Rate for Payer: EmblemHealth Commercial |
$15.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,032.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.84
|
| Rate for Payer: Group Health Inc Commercial |
$15.43
|
| Rate for Payer: Group Health Inc Medicare |
$15.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.32
|
| Rate for Payer: Healthfirst Essential Plan |
$23.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.11
|
| Rate for Payer: Healthfirst QHP |
$10.32
|
| Rate for Payer: Humana Medicare |
$15.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.32
|
| Rate for Payer: SOMOS Essential |
$10.32
|
| Rate for Payer: United Healthcare Commercial |
$14.41
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$23.22
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$11.35
|
| Rate for Payer: United Healthcare Medicaid |
$10.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.34
|
| Rate for Payer: Wellcare Medicare |
$14.66
|
|
|
INJ, PHENYLEPHRINE HCL, UP TO 1ML
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
41657114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.04
|
| Rate for Payer: Aetna Government |
$3.04
|
| Rate for Payer: Brighton Health Commercial |
$4.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| 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
|
|
|
INJ, PHENYLEPHRINE HCL, UP TO 1ML
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
41647114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.04
|
| Rate for Payer: Aetna Government |
$3.04
|
| Rate for Payer: Brighton Health Commercial |
$4.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| 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
|
|
|
INJ, PHENYLEPHRINE HCL, UP TO 1ML
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
41657114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
|
INJ, PHENYLEPHRINE HCL, UP TO 1ML
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J2370
|
| Hospital Charge Code |
41647114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
|
INJ PNB OCCIPITAL
|
Facility
|
IP
|
$792.83
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
30305014
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
INJ PNB OCCIPITAL
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
30305014
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
INJ, POTASSIUM ACETATE 4MEQ.ML
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
41646040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
INJ, POTASSIUM ACETATE 4MEQ.ML
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
41656040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
|
INJ, POTASSIUM ACETATE 4MEQ.ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41656040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$1.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
INJ, POTASSIUM ACETATE 4MEQ.ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41646040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$1.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.72
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
INJ POTASSIUM CHLORIDE PER 2 MEQ
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
41646093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
|
|
INJ POTASSIUM CHLORIDE PER 2 MEQ
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
41656093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| 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: SOMOS CHP/HARP/Medicaid |
$0.12
|
| Rate for Payer: SOMOS Essential |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
INJ POTASSIUM CHLORIDE PER 2 MEQ
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
41646093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| 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: SOMOS CHP/HARP/Medicaid |
$0.12
|
| Rate for Payer: SOMOS Essential |
$0.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
INJ POTASSIUM CHLORIDE PER 2 MEQ
|
Facility
|
IP
|
$0.14
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
41656093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
|
|
INJ., RITUXIMAB, 10 MG
|
Facility
|
OP
|
$229.98
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41657855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$149.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.20
|
| Rate for Payer: Aetna Government |
$79.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$55.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.44
|
| Rate for Payer: Brighton Health Commercial |
$137.99
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$79.20
|
| Rate for Payer: EmblemHealth Commercial |
$79.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.16
|
| Rate for Payer: Group Health Inc Commercial |
$79.20
|
| Rate for Payer: Group Health Inc Medicare |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.32
|
| Rate for Payer: Healthfirst QHP |
$79.20
|
| Rate for Payer: Humana Medicare |
$80.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.60
|
| Rate for Payer: SOMOS Essential |
$83.60
|
| Rate for Payer: United Healthcare Commercial |
$81.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63.36
|
| Rate for Payer: Wellcare Medicare |
$75.24
|
|
|
INJ., RITUXIMAB, 10 MG
|
Facility
|
IP
|
$229.98
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41657855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.99 |
| Max. Negotiated Rate |
$114.99 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.99
|
|
|
INJ., RITUXIMAB, 10 MG
|
Facility
|
IP
|
$229.98
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41647855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.99 |
| Max. Negotiated Rate |
$114.99 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.99
|
|
|
INJ., RITUXIMAB, 10 MG
|
Facility
|
OP
|
$229.98
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
41647855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$149.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.20
|
| Rate for Payer: Aetna Government |
$79.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$55.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.44
|
| Rate for Payer: Brighton Health Commercial |
$137.99
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$79.20
|
| Rate for Payer: EmblemHealth Commercial |
$79.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.16
|
| Rate for Payer: Group Health Inc Commercial |
$79.20
|
| Rate for Payer: Group Health Inc Medicare |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.32
|
| Rate for Payer: Healthfirst QHP |
$79.20
|
| Rate for Payer: Humana Medicare |
$80.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.60
|
| Rate for Payer: SOMOS Essential |
$83.60
|
| Rate for Payer: United Healthcare Commercial |
$81.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$63.36
|
| Rate for Payer: Wellcare Medicare |
$75.24
|
|
|
INJ SMALL JOINT
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
30305005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
INJ SMALL JOINT
|
Facility
|
IP
|
$792.83
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
30305005
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
INJ. TENDON ORIGIN/INSERTION SING
|
Facility
|
IP
|
$792.83
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
30303201
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
INJ. TENDON ORIGIN/INSERTION SING
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
30303201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
INJ. TENDON SHEATH/LIGAMENT SINGL
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
30301224
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
INJ. TENDON SHEATH/LIGAMENT SINGL
|
Facility
|
IP
|
$792.83
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
30301224
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$342.51
|
|
