|
IRRIGATION OF BLADDER
|
Facility
|
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
40129947
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.07 |
| 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 |
$533.59
|
| 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 |
$1,505.00
|
| 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 |
$285.81
|
| Rate for Payer: Group Health Inc Medicare |
$285.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.94
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: Humana Medicare |
$291.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
IP
|
$711.45
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
30107820
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$285.81
|
|
|
IRRIGATION OF BLADDER
|
Facility
|
IP
|
$711.45
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
40129947
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$285.81
|
|
|
IRRIGATION OF IMPL VA DEVICE PORT
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
40509876
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
IRRIGATION OF IMPL VA DEVICE PORT
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
40509876
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$124.95
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$83.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
IRRIGATION SET DISPOSABLE
|
Facility
|
OP
|
$14.53
|
|
| Hospital Charge Code |
40202720
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.26
|
| Rate for Payer: Aetna Government |
$7.26
|
| Rate for Payer: Brighton Health Commercial |
$10.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: Group Health Inc Commercial |
$7.26
|
| Rate for Payer: Group Health Inc Medicare |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
IRRIGATION SET FOR OSTOMY
|
Facility
|
OP
|
$15.24
|
|
|
Service Code
|
HCPCS A4400
|
| Hospital Charge Code |
40207907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$25.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.26
|
| Rate for Payer: Aetna Government |
$25.26
|
| Rate for Payer: Brighton Health Commercial |
$11.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.36
|
| Rate for Payer: Group Health Inc Commercial |
$7.62
|
| Rate for Payer: Group Health Inc Medicare |
$5.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.62
|
|
|
IRRIGATION STARTER SET
|
Facility
|
OP
|
$22.32
|
|
| Hospital Charge Code |
40202721
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.16
|
| Rate for Payer: Aetna Government |
$11.16
|
| Rate for Payer: Brighton Health Commercial |
$16.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.18
|
| Rate for Payer: Group Health Inc Commercial |
$11.16
|
| Rate for Payer: Group Health Inc Medicare |
$7.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.16
|
|
|
IRRIGATOR LAP HYDRO-SURG PLUS
|
Facility
|
OP
|
$118.48
|
|
| Hospital Charge Code |
64903982
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$94.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.24
|
| Rate for Payer: Aetna Government |
$59.24
|
| Rate for Payer: Brighton Health Commercial |
$88.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$94.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$80.57
|
| Rate for Payer: Group Health Inc Commercial |
$59.24
|
| Rate for Payer: Group Health Inc Medicare |
$41.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.24
|
|
|
IRRIG WOUND SIM PULSE SOLO UTREX
|
Facility
|
OP
|
$174.00
|
|
| Hospital Charge Code |
40205966
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$139.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.00
|
| Rate for Payer: Aetna Government |
$87.00
|
| Rate for Payer: Brighton Health Commercial |
$130.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$139.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$118.32
|
| Rate for Payer: Group Health Inc Commercial |
$87.00
|
| Rate for Payer: Group Health Inc Medicare |
$60.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.00
|
|
|
IRRIG WOUND SIM PULSE SOLO UTREX
|
Facility
|
OP
|
$123.39
|
|
| Hospital Charge Code |
64904635
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$98.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.70
|
| Rate for Payer: Aetna Government |
$61.70
|
| Rate for Payer: Brighton Health Commercial |
$92.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$98.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.91
|
| Rate for Payer: Group Health Inc Commercial |
$61.70
|
| Rate for Payer: Group Health Inc Medicare |
$43.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.70
|
|
|
ISAVUCONAZONIUM 186MG CAP
|
Facility
|
OP
|
$199.54
|
|
| Hospital Charge Code |
41659594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.84 |
| Max. Negotiated Rate |
$159.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.77
|
| Rate for Payer: Aetna Government |
$99.77
|
| Rate for Payer: Brighton Health Commercial |
$149.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$159.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$135.69
|
| Rate for Payer: Group Health Inc Commercial |
$99.77
|
| Rate for Payer: Group Health Inc Medicare |
$69.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.70
|
|
|
ISAVUCONAZONIUM 186MG CAP
|
Facility
|
OP
|
$199.54
|
|
| Hospital Charge Code |
41649594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.84 |
| Max. Negotiated Rate |
$159.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.77
|
| Rate for Payer: Aetna Government |
$99.77
|
| Rate for Payer: Brighton Health Commercial |
$149.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$159.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$135.69
|
| Rate for Payer: Group Health Inc Commercial |
$99.77
|
| Rate for Payer: Group Health Inc Medicare |
$69.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.70
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG PO CAPS [128209]
|
Facility
|
OP
|
$121.16
|
|
|
Service Code
|
NDC 00469052014
|
| Hospital Charge Code |
00469052014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$96.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60.58
|
| Rate for Payer: Aetna Government |
$60.58
|
| Rate for Payer: Brighton Health Commercial |
$90.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.39
|
| Rate for Payer: Group Health Inc Commercial |
$60.58
|
| Rate for Payer: Group Health Inc Medicare |
$42.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.75
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$45,764.72
|
|
|
Service Code
|
MSDRG 062
|
| Min. Negotiated Rate |
$15,476.79 |
| Max. Negotiated Rate |
$45,764.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27,598.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,283.43
|
| Rate for Payer: Aetna Government |
$33,283.43
|
| Rate for Payer: Brighton Health Commercial |
$27,139.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,949.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32,322.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,673.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,619.26
|
| Rate for Payer: EmblemHealth Commercial |
$16,049.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,283.43
|
| Rate for Payer: Group Health Inc Commercial |
$33,283.43
|
| Rate for Payer: Group Health Inc Medicare |
$33,283.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,283.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,476.79
|
| Rate for Payer: Humana Medicare |
$45,764.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,283.43
|
| Rate for Payer: United Healthcare Commercial |
$37,222.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,283.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,283.43
|
| Rate for Payer: Wellcare Medicare |
$31,619.26
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$63,518.58
|
|
|
Service Code
|
MSDRG 061
|
| Min. Negotiated Rate |
$21,480.83 |
| Max. Negotiated Rate |
$63,518.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41,327.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46,195.33
|
| Rate for Payer: Aetna Government |
$46,195.33
|
| Rate for Payer: Brighton Health Commercial |
$40,640.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47,119.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48,401.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39,943.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$43,885.56
|
| Rate for Payer: EmblemHealth Commercial |
$24,034.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$46,195.33
|
| Rate for Payer: Group Health Inc Commercial |
$46,195.33
|
| Rate for Payer: Group Health Inc Medicare |
$46,195.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46,195.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21,480.83
|
| Rate for Payer: Humana Medicare |
$63,518.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46,195.33
|
| Rate for Payer: United Healthcare Commercial |
$55,739.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,195.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46,195.33
|
| Rate for Payer: Wellcare Medicare |
$43,885.56
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$38,425.57
|
|
|
Service Code
|
MSDRG 063
|
| Min. Negotiated Rate |
$12,749.30 |
| Max. Negotiated Rate |
$38,425.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,922.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,945.87
|
| Rate for Payer: Aetna Government |
$27,945.87
|
| Rate for Payer: Brighton Health Commercial |
$21,558.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,504.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,675.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,188.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,548.58
|
| Rate for Payer: EmblemHealth Commercial |
$12,749.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,945.87
|
| Rate for Payer: Group Health Inc Commercial |
$27,945.87
|
| Rate for Payer: Group Health Inc Medicare |
$27,945.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,945.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,994.83
|
| Rate for Payer: Humana Medicare |
$38,425.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,945.87
|
| Rate for Payer: United Healthcare Commercial |
$29,567.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,945.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,945.87
|
| Rate for Payer: Wellcare Medicare |
$26,548.58
|
|
|
ISCHIECTOMY
|
Facility
|
IP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
40011200
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,285.96
|
|
|
ISCHIECTOMY
|
Facility
|
OP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
40011200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,267.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,300.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,300.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,300.17
|
| Rate for Payer: Brighton Health Commercial |
$5,267.51
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| 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 |
$3,285.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,285.96
|
| Rate for Payer: Group Health Inc Medicare |
$3,285.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,793.07
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: Humana Medicare |
$3,351.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
ISOFLEX 1944/52CM A LEAD
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
40205168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.56
|
| Rate for Payer: Aetna Government |
$28.56
|
| Rate for Payer: Brighton Health Commercial |
$720.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.00
|
| Rate for Payer: EmblemHealth Commercial |
$600.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,260.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$780.00
|
|
|
ISOFLEX 1944/52CM A LEAD
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
40205168
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|
|
ISOFLEX 1948/58CM V LEAD
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
40205167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|
|
ISOFLEX 1948/58CM V LEAD
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
40205167
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.56
|
| Rate for Payer: Aetna Government |
$28.56
|
| Rate for Payer: Brighton Health Commercial |
$720.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.00
|
| Rate for Payer: EmblemHealth Commercial |
$600.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,260.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$780.00
|
|
|
ISOFLURANE IN SOLN [4008]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 10019036040
|
| Hospital Charge Code |
10019036040
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
ISOLATION GOWN
|
Facility
|
OP
|
$12.05
|
|
| Hospital Charge Code |
40202735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Brighton Health Commercial |
$9.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
