|
M ANTIGEN
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701260
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
MAQUET 7.5FR IABP CATH 30CC
|
Facility
|
OP
|
$2,010.00
|
|
| Hospital Charge Code |
66527814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.50 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,105.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,005.00
|
| Rate for Payer: Aetna Government |
$1,005.00
|
| Rate for Payer: Brighton Health Commercial |
$1,507.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,608.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,366.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,005.00
|
| Rate for Payer: Group Health Inc Medicare |
$703.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,005.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,005.00
|
|
|
MAQUET 7.5FR IABP CATH 40CC
|
Facility
|
OP
|
$2,010.00
|
|
| Hospital Charge Code |
66527813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.50 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,105.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,005.00
|
| Rate for Payer: Aetna Government |
$1,005.00
|
| Rate for Payer: Brighton Health Commercial |
$1,507.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,608.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,366.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,005.00
|
| Rate for Payer: Group Health Inc Medicare |
$703.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,005.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,005.00
|
|
|
MAQUET 8 FR IABP CATH 68400057601
|
Facility
|
OP
|
$2,010.00
|
|
| Hospital Charge Code |
66527812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.50 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,105.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,005.00
|
| Rate for Payer: Aetna Government |
$1,005.00
|
| Rate for Payer: Brighton Health Commercial |
$1,507.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,608.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,366.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,005.00
|
| Rate for Payer: Group Health Inc Medicare |
$703.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,005.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,005.00
|
|
|
MAQUET PROCEDURE
|
Facility
|
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 27418
|
| Hospital Charge Code |
40021535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,588.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,588.37
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
MAQUET PROCEDURE
|
Facility
|
IP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 27418
|
| Hospital Charge Code |
40021535
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
MARAVIROC 150 MG PO TABS [87998]
|
Facility
|
OP
|
$34.60
|
|
|
Service Code
|
NDC 49702022318
|
| Hospital Charge Code |
49702022318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$27.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.30
|
| Rate for Payer: Aetna Government |
$17.30
|
| Rate for Payer: Brighton Health Commercial |
$25.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.53
|
| Rate for Payer: Group Health Inc Commercial |
$17.30
|
| Rate for Payer: Group Health Inc Medicare |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.49
|
|
|
MARAVIROC 150 MG TAB
|
Facility
|
OP
|
$31.61
|
|
| Hospital Charge Code |
41644797
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$25.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.80
|
| Rate for Payer: Aetna Government |
$15.80
|
| Rate for Payer: Brighton Health Commercial |
$23.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.49
|
| Rate for Payer: Group Health Inc Commercial |
$15.80
|
| Rate for Payer: Group Health Inc Medicare |
$11.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.55
|
|
|
MARAVIROC 150 MG TAB
|
Facility
|
OP
|
$31.61
|
|
| Hospital Charge Code |
41654797
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$25.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.80
|
| Rate for Payer: Aetna Government |
$15.80
|
| Rate for Payer: Brighton Health Commercial |
$23.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.49
|
| Rate for Payer: Group Health Inc Commercial |
$15.80
|
| Rate for Payer: Group Health Inc Medicare |
$11.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.55
|
|
|
MARAVIROC 300 MG PO TABS [87999]
|
Facility
|
OP
|
$34.60
|
|
|
Service Code
|
NDC 49702022418
|
| Hospital Charge Code |
49702022418
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$27.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.30
|
| Rate for Payer: Aetna Government |
$17.30
|
| Rate for Payer: Brighton Health Commercial |
$25.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.53
|
| Rate for Payer: Group Health Inc Commercial |
$17.30
|
| Rate for Payer: Group Health Inc Medicare |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.49
|
|
|
MARAVIROC 300 MG PO TABS [87999]
|
Facility
|
OP
|
$29.39
|
|
|
Service Code
|
NDC 31722058060
|
| Hospital Charge Code |
31722058060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$23.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.70
|
| Rate for Payer: Aetna Government |
$14.70
|
| Rate for Payer: Brighton Health Commercial |
$22.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.99
|
| Rate for Payer: Group Health Inc Commercial |
$14.70
|
| Rate for Payer: Group Health Inc Medicare |
$10.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.10
|
|
|
MARAVIROC 300 MG TAB
|
Facility
|
OP
|
$31.61
|
|
| Hospital Charge Code |
41654798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$25.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.80
|
| Rate for Payer: Aetna Government |
$15.80
|
| Rate for Payer: Brighton Health Commercial |
$23.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.49
|
| Rate for Payer: Group Health Inc Commercial |
$15.80
|
| Rate for Payer: Group Health Inc Medicare |
$11.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.55
|
|
|
MARAVIROC 300 MG TAB
|
Facility
|
OP
|
$31.61
|
|
| Hospital Charge Code |
41644798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$25.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.80
|
| Rate for Payer: Aetna Government |
$15.80
|
| Rate for Payer: Brighton Health Commercial |
$23.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.49
|
| Rate for Payer: Group Health Inc Commercial |
$15.80
|
| Rate for Payer: Group Health Inc Medicare |
$11.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.55
|
|
|
MARKER ENDOSCOPIC SPOT 5ML
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
40206061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.00
|
| Rate for Payer: Aetna Government |
$21.00
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
|
|
MARKER ENDOSCOPIC SPOT 5ML
|
Facility
|
OP
|
$73.75
|
|
| Hospital Charge Code |
64904180
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.88
|
| Rate for Payer: Aetna Government |
$36.88
|
| Rate for Payer: Brighton Health Commercial |
$55.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.15
|
| Rate for Payer: Group Health Inc Commercial |
$36.88
|
| Rate for Payer: Group Health Inc Medicare |
$25.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.88
|
|
|
MARKER FLEX 10G T3 SHP
|
Facility
|
OP
|
$259.82
|
|
| Hospital Charge Code |
41301574
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.94 |
| Max. Negotiated Rate |
$207.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.91
|
| Rate for Payer: Aetna Government |
$129.91
|
| Rate for Payer: Brighton Health Commercial |
$194.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$207.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.68
|
| Rate for Payer: Group Health Inc Commercial |
$129.91
|
| Rate for Payer: Group Health Inc Medicare |
$90.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.91
|
|
|
MARKER SKIN PRE-SURG NS MINI
|
Facility
|
OP
|
$0.72
|
|
| Hospital Charge Code |
64904799
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
|
|
MARLEX MESH
|
Facility
|
OP
|
$356.51
|
|
| Hospital Charge Code |
40207009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$124.78 |
| Max. Negotiated Rate |
$285.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$178.26
|
| Rate for Payer: Aetna Government |
$178.26
|
| Rate for Payer: Brighton Health Commercial |
$267.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$285.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$242.43
|
| Rate for Payer: Group Health Inc Commercial |
$178.26
|
| Rate for Payer: Group Health Inc Medicare |
$124.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.26
|
|
|
MARSUPIALIZATION BARTHOLIN'S
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
30102508
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
MARSUPIALIZATION BARTHOLIN'S
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
30102508
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| 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 |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
MARSUPIALIZATION BARTHOLIN'S
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
40052215
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
MARSUPIALIZATION BARTHOLIN'S
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
40052215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
MARSUPIALIZATION BARTHOLIN'S
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
30302438
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| 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 |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
MARSUPIALIZATION BARTHOLIN'S
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 56440
|
| Hospital Charge Code |
30302438
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
MARX TEMPORARY CONDYLAR
|
Facility
|
IP
|
$1,726.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40201199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.00 |
| Max. Negotiated Rate |
$863.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$863.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$863.00
|
|
