|
IOHEXOL 6000MG/500ML ORAL SOL
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
41648866
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
IOHEXOL 6000MG/500ML ORAL SOL
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
41658866
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
IOL, 3-PIECE LENS TECNIS ZA9003
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
64906519
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$145.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$76.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$83.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$111.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$94.52
|
| Rate for Payer: EmblemHealth Commercial |
$69.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$145.95
|
| Rate for Payer: Group Health Inc Commercial |
$69.50
|
| Rate for Payer: Group Health Inc Medicare |
$48.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.35
|
|
|
IOL ANT. CHMBR (PREC COSM)
|
Facility
|
OP
|
$872.82
|
|
| Hospital Charge Code |
40202040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$305.49 |
| Max. Negotiated Rate |
$698.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$480.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$436.41
|
| Rate for Payer: Aetna Government |
$436.41
|
| Rate for Payer: Brighton Health Commercial |
$654.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$698.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$593.52
|
| Rate for Payer: Group Health Inc Commercial |
$436.41
|
| Rate for Payer: Group Health Inc Medicare |
$305.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$436.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$436.41
|
|
|
IOL AT. CHMBR (SURGIDEV)
|
Facility
|
OP
|
$834.55
|
|
| Hospital Charge Code |
40202030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$292.09 |
| Max. Negotiated Rate |
$667.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$459.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$417.28
|
| Rate for Payer: Aetna Government |
$417.28
|
| Rate for Payer: Brighton Health Commercial |
$625.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$667.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$567.49
|
| Rate for Payer: Group Health Inc Commercial |
$417.28
|
| Rate for Payer: Group Health Inc Medicare |
$292.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$417.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$417.28
|
|
|
IOL IMPLANT
|
Facility
|
IP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66985
|
| Hospital Charge Code |
40072510
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,694.88
|
|
|
IOL IMPLANT
|
Facility
|
OP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66985
|
| Hospital Charge Code |
40072510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,592.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,886.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,886.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,886.42
|
| Rate for Payer: Brighton Health Commercial |
$4,592.78
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,694.88
|
| 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 |
$2,694.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,290.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,398.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,694.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,398.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,694.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,694.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,694.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Humana Medicare |
$2,748.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,694.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,694.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,155.90
|
| Rate for Payer: Wellcare Medicare |
$2,560.14
|
|
|
IOL LENS 19.5D
|
Facility
|
OP
|
$425.25
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40070121
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$446.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$255.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$340.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$289.17
|
| Rate for Payer: EmblemHealth Commercial |
$212.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.51
|
| Rate for Payer: Group Health Inc Commercial |
$212.62
|
| Rate for Payer: Group Health Inc Medicare |
$148.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.41
|
|
|
IOL POST CHMBR DUALENS
|
Facility
|
OP
|
$961.78
|
|
| Hospital Charge Code |
40202020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$336.62 |
| Max. Negotiated Rate |
$769.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$528.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$480.89
|
| Rate for Payer: Aetna Government |
$480.89
|
| Rate for Payer: Brighton Health Commercial |
$721.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$769.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$654.01
|
| Rate for Payer: Group Health Inc Commercial |
$480.89
|
| Rate for Payer: Group Health Inc Medicare |
$336.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$480.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$480.89
|
|
|
IOL PROSTERIOR CHAMBER
|
Facility
|
OP
|
$898.70
|
|
| Hospital Charge Code |
40202010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$314.54 |
| Max. Negotiated Rate |
$718.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$494.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$449.35
|
| Rate for Payer: Aetna Government |
$449.35
|
| Rate for Payer: Brighton Health Commercial |
$674.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$718.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$611.12
|
| Rate for Payer: Group Health Inc Commercial |
$449.35
|
| Rate for Payer: Group Health Inc Medicare |
$314.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$449.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$449.35
|
|
|
IOL REMOVAL
|
Facility
|
IP
|
$9,471.08
|
|
|
Service Code
|
HCPCS 65175
|
| Hospital Charge Code |
40072570
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,471.17
|
|
|
IOL REMOVAL
|
Facility
|
OP
|
$9,471.08
|
|
|
Service Code
|
HCPCS 65175
|
| Hospital Charge Code |
40072570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$7,103.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,471.17
|
| Rate for Payer: Aetna Government |
$4,471.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,129.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,129.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,129.82
|
| Rate for Payer: Brighton Health Commercial |
$7,103.31
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,471.17
|
| 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 |
$4,471.17
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,800.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,979.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,471.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,979.34
|
| Rate for Payer: Group Health Inc Commercial |
$4,471.17
|
| Rate for Payer: Group Health Inc Medicare |
$4,471.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,735.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,471.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,800.49
|
| Rate for Payer: Healthfirst QHP |
$4,471.17
|
| Rate for Payer: Humana Medicare |
$4,560.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,471.17
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,471.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,471.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,576.94
|
| Rate for Payer: Wellcare Medicare |
$4,247.61
|
|
|
IOMET PART KNEE TWN PEG FEM
|
Facility
|
OP
|
$6,648.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,980.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,656.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$3,988.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,324.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,822.60
|
| Rate for Payer: EmblemHealth Commercial |
$3,324.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,980.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,324.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,326.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,324.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,324.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,321.20
|
|
|
IOMET PART KNEE TWN PEG FEM
|
Facility
|
IP
|
$6,648.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,324.00 |
| Max. Negotiated Rate |
$3,324.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,324.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,324.00
|
|
|
IONIZED CALCIUM
|
Facility
|
IP
|
$34.20
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
40602465
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$13.68
|
|
|
IONIZED CALCIUM
|
Facility
|
OP
|
$34.20
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
40602465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.68
|
| Rate for Payer: Aetna Government |
$13.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.58
|
| Rate for Payer: Brighton Health Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.68
|
| Rate for Payer: EmblemHealth Commercial |
$13.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.18
|
| Rate for Payer: Group Health Inc Commercial |
$13.68
|
| Rate for Payer: Group Health Inc Medicare |
$13.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.68
|
| Rate for Payer: Healthfirst QHP |
$13.68
|
| Rate for Payer: Humana Medicare |
$13.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.68
|
| Rate for Payer: United Healthcare Commercial |
$17.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.94
|
| Rate for Payer: Wellcare Medicare |
$12.31
|
|
|
IOPAMIDOL 300 MG/ML INJ 50 ML
|
Facility
|
OP
|
$0.35
|
|
| Hospital Charge Code |
41653181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Brighton Health Commercial |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
IOPAMIDOL 300 MG/ML INJ 50 ML
|
Facility
|
OP
|
$0.35
|
|
| Hospital Charge Code |
41643181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Brighton Health Commercial |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
IPECAC ADMINISTRATION
|
Facility
|
OP
|
$83.20
|
|
|
Service Code
|
HCPCS 99175
|
| Hospital Charge Code |
30103300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.42
|
| Rate for Payer: Aetna Government |
$15.42
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
IPECAC SYRUP 30 ML
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41653495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
IPECAC SYRUP 30 ML
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41643495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
IPILIMUMAB
|
Facility
|
OP
|
$393.45
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
41640369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.69 |
| Max. Negotiated Rate |
$255.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.42
|
| Rate for Payer: Aetna Government |
$172.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$120.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$120.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$120.69
|
| Rate for Payer: Brighton Health Commercial |
$236.07
|
| Rate for Payer: Cash Price |
$172.42
|
| Rate for Payer: Cash Price |
$172.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$172.42
|
| Rate for Payer: EmblemHealth Commercial |
$172.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.04
|
| Rate for Payer: Group Health Inc Commercial |
$172.42
|
| Rate for Payer: Group Health Inc Medicare |
$172.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.56
|
| Rate for Payer: Healthfirst QHP |
$172.42
|
| Rate for Payer: Humana Medicare |
$175.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.07
|
| Rate for Payer: SOMOS Essential |
$183.07
|
| Rate for Payer: United Healthcare Commercial |
$165.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$137.94
|
| Rate for Payer: Wellcare Medicare |
$163.80
|
|
|
IPILIMUMAB
|
Facility
|
IP
|
$393.45
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
41650369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.72 |
| Max. Negotiated Rate |
$196.72 |
| Rate for Payer: Cash Price |
$172.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.72
|
|
|
IPILIMUMAB
|
Facility
|
IP
|
$393.45
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
41640369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$196.72 |
| Max. Negotiated Rate |
$196.72 |
| Rate for Payer: Cash Price |
$172.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.72
|
|
|
IPILIMUMAB
|
Facility
|
OP
|
$393.45
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
41650369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.69 |
| Max. Negotiated Rate |
$255.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.42
|
| Rate for Payer: Aetna Government |
$172.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$120.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$120.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$120.69
|
| Rate for Payer: Brighton Health Commercial |
$236.07
|
| Rate for Payer: Cash Price |
$172.42
|
| Rate for Payer: Cash Price |
$172.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$172.42
|
| Rate for Payer: EmblemHealth Commercial |
$172.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.04
|
| Rate for Payer: Group Health Inc Commercial |
$172.42
|
| Rate for Payer: Group Health Inc Medicare |
$172.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.56
|
| Rate for Payer: Healthfirst QHP |
$172.42
|
| Rate for Payer: Humana Medicare |
$175.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.07
|
| Rate for Payer: SOMOS Essential |
$183.07
|
| Rate for Payer: United Healthcare Commercial |
$165.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$137.94
|
| Rate for Payer: Wellcare Medicare |
$163.80
|
|
