|
IV INFUS (ANTI EMETIC INIT 1 HR)
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
30306673
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
IV INFUS(ANTI EMETIC) INITIAL 1HR
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
30103252
|
|
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 INFUS(ANTI EMETIC) INITIAL 1HR
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
30103252
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
IV INFUSION EACH ADD'1 HR
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
40509894
|
|
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 INFUSION EACH ADD'1 HR
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
40509894
|
|
Hospital Revenue Code
|
269
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
IV INFUSION,INITIAL UP TO 1 HR
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
40509893
|
|
Hospital Revenue Code
|
269
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
IV INFUSION,INITIAL UP TO 1 HR
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
40509893
|
|
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 INFUSION THERAPY 1 HOUR
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
30304085
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
IV INFUSION THERAPY 1 HOUR
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
30100170
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
IV INFUSION THERAPY 1 HOUR
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
30100170
|
|
Hospital Revenue Code
|
260
|
| 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 INFUSION THERAPY 1 HOUR
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
30304085
|
|
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
|
|
|
IV INFUSION THERAPY EACH ADD HOUR
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
30103084
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
IV INFUSION THERAPY EACH ADD HOUR
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96366
|
| Hospital Charge Code |
30103084
|
|
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 KIT CHEMO
|
Facility
|
OP
|
$34.50
|
|
|
Service Code
|
HCPCS 99070
|
| Hospital Charge Code |
40500017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.26
|
| Rate for Payer: Aetna Government |
$10.26
|
| Rate for Payer: Brighton Health Commercial |
$25.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.46
|
| Rate for Payer: Group Health Inc Commercial |
$17.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.25
|
|
|
IV KIT NON CHEMO
|
Facility
|
OP
|
$34.50
|
|
|
Service Code
|
HCPCS 99070
|
| Hospital Charge Code |
40500018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.26
|
| Rate for Payer: Aetna Government |
$10.26
|
| Rate for Payer: Brighton Health Commercial |
$25.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.46
|
| Rate for Payer: Group Health Inc Commercial |
$17.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.25
|
|
|
IV NS .9% 100ML SINGLE-PK
|
Facility
|
OP
|
$2.93
|
|
| Hospital Charge Code |
64901366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.46
|
| Rate for Payer: Aetna Government |
$1.46
|
| Rate for Payer: Brighton Health Commercial |
$2.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.99
|
| Rate for Payer: Group Health Inc Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.46
|
|
|
IV NS .9% 50ML SINGLE-PK
|
Facility
|
OP
|
$2.93
|
|
| Hospital Charge Code |
64901369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.46
|
| Rate for Payer: Aetna Government |
$1.46
|
| Rate for Payer: Brighton Health Commercial |
$2.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.99
|
| Rate for Payer: Group Health Inc Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.46
|
|
|
IVP INJECTION
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
30103281
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
IVP INJECTION
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
30103281
|
|
Hospital Revenue Code
|
260
|
| 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 PUMP & CASSETTE (PER DAY)
|
Facility
|
OP
|
$34.38
|
|
| Hospital Charge Code |
40207621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.19
|
| Rate for Payer: Aetna Government |
$17.19
|
| Rate for Payer: Brighton Health Commercial |
$25.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.38
|
| Rate for Payer: Group Health Inc Commercial |
$17.19
|
| Rate for Payer: Group Health Inc Medicare |
$12.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.19
|
|
|
IV PUSH SUBSTANCE/DRUG INITIAL
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
40509906
|
|
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 PUSH SUBSTANCE/DRUG INITIAL
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
40509906
|
|
Hospital Revenue Code
|
269
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
IV SEDATION EACH 15M
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS D9243
|
| Hospital Charge Code |
42303474
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.61 |
| Max. Negotiated Rate |
$29,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$261.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.61
|
| Rate for Payer: Aetna Government |
$40.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$668.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$668.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$297.22
|
| Rate for Payer: Amida Care Medicaid |
$297.22
|
| Rate for Payer: Brighton Health Commercial |
$356.25
|
| 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: Fidelis CHP/HARP/Medicaid |
$29,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$297.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$312.08
|
| Rate for Payer: Group Health Inc Commercial |
$237.50
|
| Rate for Payer: Group Health Inc Medicare |
$166.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.22
|
| Rate for Payer: Healthfirst Essential Plan |
$668.74
|
| Rate for Payer: Healthfirst QHP |
$297.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.22
|
| Rate for Payer: SOMOS Essential |
$668.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$668.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$326.94
|
| Rate for Payer: United Healthcare Medicaid |
$297.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$297.22
|
|
|
I.V.SET
|
Facility
|
OP
|
$14.53
|
|
| Hospital Charge Code |
40202710
|
|
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
|
|
|
IVSETINTERLINKBASICSOL.L/F2C6419
|
Facility
|
OP
|
$2.34
|
|
| Hospital Charge Code |
40209475
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.17
|
| Rate for Payer: Aetna Government |
$1.17
|
| Rate for Payer: Brighton Health Commercial |
$1.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.59
|
| Rate for Payer: Group Health Inc Commercial |
$1.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.17
|
|
