|
PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR [40475]
|
Facility
|
OP
|
$1,896.07
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
68817013450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$1,232.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,042.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.29
|
| Rate for Payer: Aetna Government |
$14.29
|
| Rate for Payer: Brighton Health Commercial |
$1,137.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$948.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,090.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.29
|
| Rate for Payer: EmblemHealth Commercial |
$948.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.29
|
| Rate for Payer: Group Health Inc Commercial |
$14.29
|
| Rate for Payer: Group Health Inc Medicare |
$14.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$948.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$948.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.15
|
| Rate for Payer: Healthfirst QHP |
$14.29
|
| Rate for Payer: Humana Medicare |
$14.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,232.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.44
|
|
|
PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR [40475]
|
Facility
|
IP
|
$1,706.46
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
24979071051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$853.23 |
| Max. Negotiated Rate |
$853.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$853.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$853.23
|
|
|
PACLITAXEL PROTEIN-BOUND PART 100 MG IV SUSR [40475]
|
Facility
|
OP
|
$1,706.46
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
24979071051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$1,109.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$938.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.29
|
| Rate for Payer: Aetna Government |
$14.29
|
| Rate for Payer: Brighton Health Commercial |
$1,023.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$853.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$981.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.29
|
| Rate for Payer: EmblemHealth Commercial |
$853.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.29
|
| Rate for Payer: Group Health Inc Commercial |
$14.29
|
| Rate for Payer: Group Health Inc Medicare |
$14.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$853.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$853.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.15
|
| Rate for Payer: Healthfirst QHP |
$14.29
|
| Rate for Payer: Humana Medicare |
$14.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,109.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.44
|
|
|
PACU ADDITIONAL 1/2 HOUR
|
Facility
|
OP
|
$206.25
|
|
| Hospital Charge Code |
40004407
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$113.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.12
|
| Rate for Payer: Aetna Government |
$103.12
|
| Rate for Payer: Brighton Health Commercial |
$154.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.25
|
| Rate for Payer: Group Health Inc Commercial |
$103.12
|
| Rate for Payer: Group Health Inc Medicare |
$72.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.12
|
|
|
PACU PHASE 1
|
Facility
|
OP
|
$312.50
|
|
| Hospital Charge Code |
64900706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$109.38 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.25
|
| Rate for Payer: Aetna Government |
$156.25
|
| Rate for Payer: Brighton Health Commercial |
$234.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$212.50
|
| Rate for Payer: Group Health Inc Commercial |
$156.25
|
| Rate for Payer: Group Health Inc Medicare |
$109.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.25
|
|
|
PACU PHASE 1
|
Facility
|
OP
|
$312.50
|
|
| Hospital Charge Code |
40004405
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$109.38 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.25
|
| Rate for Payer: Aetna Government |
$156.25
|
| Rate for Payer: Brighton Health Commercial |
$234.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$212.50
|
| Rate for Payer: Group Health Inc Commercial |
$156.25
|
| Rate for Payer: Group Health Inc Medicare |
$109.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.25
|
|
|
PACU PHASE 1 ADD 15 MIN
|
Facility
|
OP
|
$103.13
|
|
| Hospital Charge Code |
40194407
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.56
|
| Rate for Payer: Aetna Government |
$51.56
|
| Rate for Payer: Brighton Health Commercial |
$77.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.13
|
| Rate for Payer: Group Health Inc Commercial |
$51.56
|
| Rate for Payer: Group Health Inc Medicare |
$36.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.56
|
|
|
PACU PHASE 1 ADD'L 1/2 HOUR
|
Facility
|
OP
|
$206.25
|
|
| Hospital Charge Code |
64900708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$113.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.12
|
| Rate for Payer: Aetna Government |
$103.12
|
| Rate for Payer: Brighton Health Commercial |
$154.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.25
|
| Rate for Payer: Group Health Inc Commercial |
$103.12
|
| Rate for Payer: Group Health Inc Medicare |
$72.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.12
|
|
|
PACU PHASE 1 FIRST HOUR
|
Facility
|
OP
|
$312.50
|
|
| Hospital Charge Code |
40194405
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$109.38 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.25
|
| Rate for Payer: Aetna Government |
$156.25
|
| Rate for Payer: Brighton Health Commercial |
$234.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$212.50
|
| Rate for Payer: Group Health Inc Commercial |
$156.25
|
| Rate for Payer: Group Health Inc Medicare |
$109.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.25
|
|
|
PACU PHASE 2
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
64900707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.00
|
| Rate for Payer: Aetna Government |
$125.00
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
PACU PHASE 2
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
40004406
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.00
|
| Rate for Payer: Aetna Government |
$125.00
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
PACU PHASE 2 ADD 15 MIN
|
Facility
|
OP
|
$82.50
|
|
| Hospital Charge Code |
40194408
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.25
|
| Rate for Payer: Aetna Government |
$41.25
|
| Rate for Payer: Brighton Health Commercial |
$61.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.10
|
| Rate for Payer: Group Health Inc Commercial |
$41.25
|
| Rate for Payer: Group Health Inc Medicare |
$28.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.25
|
|
|
PACU PHASE 2 ADDITIONAL 1/2 HOUR
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
40004408
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$82.50
|
| Rate for Payer: Aetna Government |
$82.50
|
| Rate for Payer: Brighton Health Commercial |
$123.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.20
|
| Rate for Payer: Group Health Inc Commercial |
$82.50
|
| Rate for Payer: Group Health Inc Medicare |
$57.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
|
|
PACU PHASE 2 ADD'L 1/2 HOUR
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
64900709
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$82.50
|
| Rate for Payer: Aetna Government |
$82.50
|
| Rate for Payer: Brighton Health Commercial |
$123.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.20
|
| Rate for Payer: Group Health Inc Commercial |
$82.50
|
| Rate for Payer: Group Health Inc Medicare |
$57.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
|
|
PACU PHASE 2 FIRST HOUR
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
40194406
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.00
|
| Rate for Payer: Aetna Government |
$125.00
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
PAD AIREY BALANCE 2-1/4 16X20
|
Facility
|
OP
|
$114.98
|
|
| Hospital Charge Code |
64903312
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$91.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.49
|
| Rate for Payer: Aetna Government |
$57.49
|
| Rate for Payer: Brighton Health Commercial |
$86.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$91.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.19
|
| Rate for Payer: Group Health Inc Commercial |
$57.49
|
| Rate for Payer: Group Health Inc Medicare |
$40.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.49
|
|
|
PAD CAUTERY CLEAN ELEC SURG TIPS
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
64906325
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
PAD CPM REPLACEMENT OPTIFLEX
|
Facility
|
OP
|
$43.95
|
|
| Hospital Charge Code |
64904252
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$35.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.98
|
| Rate for Payer: Aetna Government |
$21.98
|
| Rate for Payer: Brighton Health Commercial |
$32.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.89
|
| Rate for Payer: Group Health Inc Commercial |
$21.98
|
| Rate for Payer: Group Health Inc Medicare |
$15.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.98
|
|
|
PADDING CAST 4 STERILE
|
Facility
|
OP
|
$3.07
|
|
| Hospital Charge Code |
64902791
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.54
|
| Rate for Payer: Aetna Government |
$1.54
|
| Rate for Payer: Brighton Health Commercial |
$2.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.09
|
| Rate for Payer: Group Health Inc Commercial |
$1.54
|
| Rate for Payer: Group Health Inc Medicare |
$1.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.54
|
|
|
PADDING CAST 4 STERILE
|
Facility
|
OP
|
$5.44
|
|
| Hospital Charge Code |
40202182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.72
|
| Rate for Payer: Aetna Government |
$2.72
|
| Rate for Payer: Brighton Health Commercial |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.70
|
| Rate for Payer: Group Health Inc Commercial |
$2.72
|
| Rate for Payer: Group Health Inc Medicare |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.72
|
|
|
PADDING CAST 6 STERILE
|
Facility
|
OP
|
$9.15
|
|
| Hospital Charge Code |
40200409
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.58
|
| Rate for Payer: Aetna Government |
$4.58
|
| Rate for Payer: Brighton Health Commercial |
$6.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.22
|
| Rate for Payer: Group Health Inc Commercial |
$4.58
|
| Rate for Payer: Group Health Inc Medicare |
$3.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.58
|
|
|
PADDING CAST 6 WEBRIL STERILE
|
Facility
|
OP
|
$0.48
|
|
| Hospital Charge Code |
64902760
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Brighton Health Commercial |
$0.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
|
|
PADDING,CAST,WEBRIL,NS A
|
Facility
|
OP
|
$2.73
|
|
| Hospital Charge Code |
64901159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.36
|
| Rate for Payer: Aetna Government |
$1.36
|
| Rate for Payer: Brighton Health Commercial |
$2.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.86
|
| Rate for Payer: Group Health Inc Commercial |
$1.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.36
|
|
|
PADDING,CAST,WEBRIL,NS B
|
Facility
|
OP
|
$3.87
|
|
| Hospital Charge Code |
64901177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.94
|
| Rate for Payer: Aetna Government |
$1.94
|
| Rate for Payer: Brighton Health Commercial |
$2.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.63
|
| Rate for Payer: Group Health Inc Commercial |
$1.94
|
| Rate for Payer: Group Health Inc Medicare |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.94
|
|
|
PAD ELECTROSURGICAL GROUNDING
|
Facility
|
OP
|
$5.66
|
|
| Hospital Charge Code |
64902459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.83
|
| Rate for Payer: Aetna Government |
$2.83
|
| Rate for Payer: Brighton Health Commercial |
$4.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.85
|
| Rate for Payer: Group Health Inc Commercial |
$2.83
|
| Rate for Payer: Group Health Inc Medicare |
$1.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.83
|
|
