|
IRINOTECAN HCL 100 MG/5ML IV SOLN [91054]
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
45963061455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$3.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.61
|
|
|
IRINOTECAN HCL 100 MG/5ML IV SOLN [91054]
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
60505612801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$7.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.35
|
| Rate for Payer: Aetna Government |
$2.35
|
| Rate for Payer: Brighton Health Commercial |
$4.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.15
|
| Rate for Payer: EmblemHealth Commercial |
$3.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.57
|
| Rate for Payer: Group Health Inc Commercial |
$3.61
|
| Rate for Payer: Group Health Inc Medicare |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.69
|
|
|
IRINOTECAN HCL 100 MG/5ML IV SOLN [91054]
|
Facility
|
IP
|
$7.21
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
70700017022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$3.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.61
|
|
|
IRINOTECAN HCL 100 MG/5ML IV SOLN [91054]
|
Facility
|
OP
|
$7.21
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
45963061455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$7.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.35
|
| Rate for Payer: Aetna Government |
$2.35
|
| Rate for Payer: Brighton Health Commercial |
$4.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.15
|
| Rate for Payer: EmblemHealth Commercial |
$3.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.57
|
| Rate for Payer: Group Health Inc Commercial |
$3.61
|
| Rate for Payer: Group Health Inc Medicare |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.69
|
|
|
IRINOTECAN HCL LIPOSOME 43 MG/10ML IV INJ [130463]
|
Facility
|
IP
|
$331.92
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
15054004301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$165.96 |
| Max. Negotiated Rate |
$165.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.96
|
|
|
IRINOTECAN HCL LIPOSOME 43 MG/10ML IV INJ [130463]
|
Facility
|
OP
|
$331.92
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
15054004301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.62 |
| Max. Negotiated Rate |
$215.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$182.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.02
|
| Rate for Payer: Aetna Government |
$62.02
|
| Rate for Payer: Brighton Health Commercial |
$199.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$190.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.02
|
| Rate for Payer: EmblemHealth Commercial |
$165.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.02
|
| Rate for Payer: Group Health Inc Commercial |
$62.02
|
| Rate for Payer: Group Health Inc Medicare |
$62.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.72
|
| Rate for Payer: Healthfirst QHP |
$62.02
|
| Rate for Payer: Humana Medicare |
$63.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$215.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$49.62
|
|
|
IRON SUCROSE 200 MG/10ML INJ
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
41657023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.27
|
| Rate for Payer: Amida Care Medicaid |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.27
|
| Rate for Payer: Healthfirst Essential Plan |
$0.61
|
| Rate for Payer: Healthfirst QHP |
$0.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: SOMOS Essential |
$0.27
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.30
|
| Rate for Payer: United Healthcare Medicaid |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.27
|
|
|
IRON SUCROSE 200 MG/10ML INJ
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
41657023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
|
|
IRON SUCROSE 200MG/10ML INJ
|
Facility
|
OP
|
$0.40
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
41647023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.27
|
| Rate for Payer: Amida Care Medicaid |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.27
|
| Rate for Payer: Healthfirst Essential Plan |
$0.61
|
| Rate for Payer: Healthfirst QHP |
$0.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: SOMOS Essential |
$0.27
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.30
|
| Rate for Payer: United Healthcare Medicaid |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.27
|
|
|
IRON SUCROSE 200MG/10ML INJ
|
Facility
|
IP
|
$0.40
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
41647023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
|
|
IRON SUCROSE 20 MG/ML IV SOLN [29132]
|
Facility
|
IP
|
$14.69
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
00517231005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$7.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.35
|
|
|
IRON SUCROSE 20 MG/ML IV SOLN [29132]
|
Facility
|
IP
|
$14.69
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
00517234010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$7.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.35
|
|
|
IRON SUCROSE 20 MG/ML IV SOLN [29132]
|
Facility
|
OP
|
$14.69
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
00517234010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.27
|
| Rate for Payer: Amida Care Medicaid |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$8.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.45
|
| Rate for Payer: EmblemHealth Commercial |
$7.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$7.35
|
| Rate for Payer: Group Health Inc Medicare |
$5.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.27
|
| Rate for Payer: Healthfirst Essential Plan |
$0.61
|
| Rate for Payer: Healthfirst QHP |
$0.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: SOMOS Essential |
$0.27
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.30
|
| Rate for Payer: United Healthcare Medicaid |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.27
|
|
|
IRON SUCROSE 20 MG/ML IV SOLN [29132]
|
Facility
|
OP
|
$14.69
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
00517231005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.27
|
| Rate for Payer: Amida Care Medicaid |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$8.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.45
|
| Rate for Payer: EmblemHealth Commercial |
$7.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$7.35
|
| Rate for Payer: Group Health Inc Medicare |
$5.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.27
|
| Rate for Payer: Healthfirst Essential Plan |
$0.61
|
| Rate for Payer: Healthfirst QHP |
$0.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: SOMOS Essential |
$0.27
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.30
|
| Rate for Payer: United Healthcare Medicaid |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.27
|
|
|
IRON SUCROSE INJ 1 MG
|
Facility
|
OP
|
$3.28
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
41647017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.27
|
| Rate for Payer: Amida Care Medicaid |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$1.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$1.64
|
| Rate for Payer: Group Health Inc Medicare |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.27
|
| Rate for Payer: Healthfirst Essential Plan |
$0.61
|
| Rate for Payer: Healthfirst QHP |
$0.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: SOMOS Essential |
$0.27
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.30
|
| Rate for Payer: United Healthcare Medicaid |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.27
|
|
|
IRON SUCROSE INJ 1 MG
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
41647017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.64
|
|
|
IRON SUCROSE INJ 1 MG
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
41657017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.64
|
|
|
IRON SUCROSE INJ 1 MG
|
Facility
|
OP
|
$3.28
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
41657017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$0.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$0.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$0.27
|
| Rate for Payer: Amida Care Medicaid |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$1.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$1.64
|
| Rate for Payer: Group Health Inc Medicare |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.27
|
| Rate for Payer: Healthfirst Essential Plan |
$0.61
|
| Rate for Payer: Healthfirst QHP |
$0.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: SOMOS Essential |
$0.27
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$0.61
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$0.30
|
| Rate for Payer: United Healthcare Medicaid |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.27
|
|
|
IRON,TOTAL SERUM
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
40602400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.53
|
| Rate for Payer: Brighton Health Commercial |
$12.14
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Humana Medicare |
$6.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
IRON,TOTAL SERUM
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
40602400
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$6.47
|
|
|
IRRADIATION FEE
|
Facility
|
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 86945
|
| Hospital Charge Code |
40701194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$75.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.38
|
| Rate for Payer: Aetna Government |
$46.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.47
|
| Rate for Payer: Brighton Health Commercial |
$75.94
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.38
|
| Rate for Payer: EmblemHealth Commercial |
$46.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Group Health Inc Commercial |
$46.38
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.38
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: Humana Medicare |
$47.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: United Healthcare Commercial |
$13.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Wellcare Medicare |
$41.74
|
|
|
IRRADIATION FEE
|
Facility
|
IP
|
$101.25
|
|
|
Service Code
|
HCPCS 86945
|
| Hospital Charge Code |
40701194
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$46.38
|
|
|
IRRGATOR LAP HYDRO SURG PLUS
|
Facility
|
OP
|
$195.00
|
|
| Hospital Charge Code |
40205965
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$97.50
|
| Rate for Payer: Aetna Government |
$97.50
|
| Rate for Payer: Brighton Health Commercial |
$146.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$156.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.60
|
| Rate for Payer: Group Health Inc Commercial |
$97.50
|
| Rate for Payer: Group Health Inc Medicare |
$68.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.50
|
|
|
IRRIGATION KIT
|
Facility
|
OP
|
$127.50
|
|
| Hospital Charge Code |
64907338
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.75
|
| Rate for Payer: Aetna Government |
$63.75
|
| Rate for Payer: Brighton Health Commercial |
$95.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.70
|
| Rate for Payer: Group Health Inc Commercial |
$63.75
|
| Rate for Payer: Group Health Inc Medicare |
$44.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.75
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
30107820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$200.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$200.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$200.07
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$285.81
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| 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 |
$285.81
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| 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 |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: Humana Medicare |
$291.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
