|
ITRACONAZOLE 10 MG/ML PO SOLN [19928]
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 31722000631
|
| Hospital Charge Code |
31722000631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.23
|
| Rate for Payer: Aetna Government |
$1.23
|
| Rate for Payer: Brighton Health Commercial |
$1.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.68
|
| Rate for Payer: Group Health Inc Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.60
|
|
|
IUD INSERTION
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 58300
|
| Hospital Charge Code |
30301255
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.24
|
| Rate for Payer: Aetna Government |
$67.24
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
IUD MIRENA
|
Facility
|
OP
|
$805.63
|
|
| Hospital Charge Code |
64903382
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$281.97 |
| Max. Negotiated Rate |
$644.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$443.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.82
|
| Rate for Payer: Aetna Government |
$402.82
|
| Rate for Payer: Brighton Health Commercial |
$604.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.83
|
| Rate for Payer: Group Health Inc Commercial |
$402.82
|
| Rate for Payer: Group Health Inc Medicare |
$281.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$402.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$402.82
|
|
|
IUD PARAGARD T380A
|
Facility
|
OP
|
$616.70
|
|
| Hospital Charge Code |
64903384
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$215.84 |
| Max. Negotiated Rate |
$493.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$339.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$308.35
|
| Rate for Payer: Aetna Government |
$308.35
|
| Rate for Payer: Brighton Health Commercial |
$462.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$493.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$419.36
|
| Rate for Payer: Group Health Inc Commercial |
$308.35
|
| Rate for Payer: Group Health Inc Medicare |
$215.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.35
|
|
|
I.V. ADMINISTRATION SET
|
Facility
|
OP
|
$6.03
|
|
| Hospital Charge Code |
40190315
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$4.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$2.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
|
|
I.V. CATHETER
|
Facility
|
OP
|
$6.03
|
|
| Hospital Charge Code |
40509810
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$4.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$2.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
IV CONNECTOR W/ LUER SLIP ADAPTER
|
Facility
|
OP
|
$4.74
|
|
| Hospital Charge Code |
64902288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.37
|
| Rate for Payer: Aetna Government |
$2.37
|
| Rate for Payer: Brighton Health Commercial |
$3.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.22
|
| Rate for Payer: Group Health Inc Commercial |
$2.37
|
| Rate for Payer: Group Health Inc Medicare |
$1.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.37
|
|
|
IV D5%/.2%NACL 1000ML
|
Facility
|
OP
|
$3.54
|
|
| Hospital Charge Code |
64901037
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$2.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Brighton Health Commercial |
$2.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.41
|
| Rate for Payer: Group Health Inc Commercial |
$1.77
|
| Rate for Payer: Group Health Inc Medicare |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.77
|
|
|
IV DEX 10% 250ML (BG)
|
Facility
|
OP
|
$4.05
|
|
| Hospital Charge Code |
64902079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.02
|
| Rate for Payer: Aetna Government |
$2.02
|
| Rate for Payer: Brighton Health Commercial |
$3.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.75
|
| Rate for Payer: Group Health Inc Commercial |
$2.02
|
| Rate for Payer: Group Health Inc Medicare |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.02
|
|
|
IVERMECTIN 3 MG PO TABS [25820]
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
NDC 00006003220
|
| Hospital Charge Code |
00006003220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.79
|
| Rate for Payer: Aetna Government |
$2.79
|
| Rate for Payer: Brighton Health Commercial |
$4.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$2.79
|
| Rate for Payer: Group Health Inc Medicare |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.63
|
|
|
IVERMECTIN 3 MG PO TABS [25820]
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
NDC 42799080601
|
| Hospital Charge Code |
42799080601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Brighton Health Commercial |
$3.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.23
|
|
|
IVERMECTIN 3 MG TAB - NF
|
Facility
|
OP
|
$9.21
|
|
| Hospital Charge Code |
41644942
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.60
|
| Rate for Payer: Aetna Government |
$4.60
|
| Rate for Payer: Brighton Health Commercial |
$6.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.26
|
| Rate for Payer: Group Health Inc Commercial |
$4.60
|
| Rate for Payer: Group Health Inc Medicare |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.99
|
|
|
IVERMECTIN 3 MG TAB - NF
|
Facility
|
OP
|
$9.21
|
|
| Hospital Charge Code |
41654942
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.60
|
| Rate for Payer: Aetna Government |
$4.60
|
| Rate for Payer: Brighton Health Commercial |
$6.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.26
|
| Rate for Payer: Group Health Inc Commercial |
$4.60
|
| Rate for Payer: Group Health Inc Medicare |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.99
|
|
|
IV EXT SET, 6.5, 0.7ML, NON
|
Facility
|
OP
|
$6.06
|
|
| Hospital Charge Code |
64901645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.03
|
| Rate for Payer: Aetna Government |
$3.03
|
| Rate for Payer: Brighton Health Commercial |
$4.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.12
|
| Rate for Payer: Group Health Inc Commercial |
$3.03
|
| Rate for Payer: Group Health Inc Medicare |
$2.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.03
|
|
|
IV FUSION THERAPY ADD'L HOUR
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
30101162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$173.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$173.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$173.51
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$247.87
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| 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 |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Humana Medicare |
$252.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
IV FUSION THERAPY ADD'L HOUR
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
30101162
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
IV HYDRATION ONLY EACH ADD'1 HR
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
40509877
|
|
Hospital Revenue Code
|
269
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$30,767.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$692.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$692.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.67
|
| Rate for Payer: Amida Care Medicaid |
$307.67
|
| Rate for Payer: Brighton Health Commercial |
$86.57
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: EmblemHealth Commercial |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,767.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$54.93
|
| Rate for Payer: Group Health Inc Medicare |
$54.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.67
|
| Rate for Payer: Healthfirst Essential Plan |
$692.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$307.67
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.67
|
| Rate for Payer: SOMOS Essential |
$692.26
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$692.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$338.44
|
| Rate for Payer: United Healthcare Medicaid |
$307.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
IV HYDRATION ONLY EACH ADD'1 HR
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
40509862
|
|
Hospital Revenue Code
|
269
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$445.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$173.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$173.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$173.51
|
| Rate for Payer: Brighton Health Commercial |
$417.38
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$445.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$247.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| Rate for Payer: Group Health Inc Commercial |
$247.87
|
| Rate for Payer: Group Health Inc Medicare |
$247.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Humana Medicare |
$252.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
IV HYDRATION ONLY EACH ADD'1 HR
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
40509877
|
|
Hospital Revenue Code
|
269
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
IV HYDRATION ONLY EACH ADD'1 HR
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
40509862
|
|
Hospital Revenue Code
|
269
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
IV INF, TX/DX, EACH ADD'L HOUR
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
30304086
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
IV INF, TX/DX, EACH ADD'L HOUR
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
30103251
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
IV INF, TX/DX, EACH ADD'L HOUR
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
30103251
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$30,767.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$692.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$692.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.67
|
| Rate for Payer: Amida Care Medicaid |
$307.67
|
| Rate for Payer: Brighton Health Commercial |
$86.57
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: EmblemHealth Commercial |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,767.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$54.93
|
| Rate for Payer: Group Health Inc Medicare |
$54.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.67
|
| Rate for Payer: Healthfirst Essential Plan |
$692.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$307.67
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.67
|
| Rate for Payer: SOMOS Essential |
$692.26
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$692.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$338.44
|
| Rate for Payer: United Healthcare Medicaid |
$307.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
IV INF, TX/DX, EACH ADD'L HOUR
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
30304086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$30,767.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$692.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$692.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.67
|
| Rate for Payer: Amida Care Medicaid |
$307.67
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,767.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.67
|
| Rate for Payer: Healthfirst Essential Plan |
$692.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$307.67
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.67
|
| Rate for Payer: SOMOS Essential |
$692.26
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$692.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$338.44
|
| Rate for Payer: United Healthcare Medicaid |
$307.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
IV INFUS (ANTI EMETIC INIT 1 HR)
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
30306673
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.51 |
| Max. Negotiated Rate |
$306.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$173.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$173.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$173.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| 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 |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Humana Medicare |
$252.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
