|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC
|
Facility
|
IP
|
$30,872.88
|
|
|
Service Code
|
MSDRG 543
|
| Min. Negotiated Rate |
$9,352.75 |
| Max. Negotiated Rate |
$30,872.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,082.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,453.00
|
| Rate for Payer: Aetna Government |
$22,453.00
|
| Rate for Payer: Brighton Health Commercial |
$15,815.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,902.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,835.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,543.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,330.35
|
| Rate for Payer: EmblemHealth Commercial |
$9,352.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,453.00
|
| Rate for Payer: Group Health Inc Commercial |
$22,453.00
|
| Rate for Payer: Group Health Inc Medicare |
$22,453.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,453.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,440.64
|
| Rate for Payer: Humana Medicare |
$30,872.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,453.00
|
| Rate for Payer: United Healthcare Commercial |
$21,690.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,453.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,453.00
|
| Rate for Payer: Wellcare Medicare |
$21,330.35
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$44,849.48
|
|
|
Service Code
|
MSDRG 542
|
| Min. Negotiated Rate |
$15,167.28 |
| Max. Negotiated Rate |
$44,849.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,890.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,617.80
|
| Rate for Payer: Aetna Government |
$32,617.80
|
| Rate for Payer: Brighton Health Commercial |
$26,443.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,270.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,493.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,989.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,986.91
|
| Rate for Payer: EmblemHealth Commercial |
$15,638.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,617.80
|
| Rate for Payer: Group Health Inc Commercial |
$32,617.80
|
| Rate for Payer: Group Health Inc Medicare |
$32,617.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,617.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,167.28
|
| Rate for Payer: Humana Medicare |
$44,849.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,617.80
|
| Rate for Payer: United Healthcare Commercial |
$36,267.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,617.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,617.80
|
| Rate for Payer: Wellcare Medicare |
$30,986.91
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$24,710.19
|
|
|
Service Code
|
MSDRG 544
|
| Min. Negotiated Rate |
$6,581.31 |
| Max. Negotiated Rate |
$24,710.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,316.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,971.05
|
| Rate for Payer: Aetna Government |
$17,971.05
|
| Rate for Payer: Brighton Health Commercial |
$11,128.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,330.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,253.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,937.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,072.50
|
| Rate for Payer: EmblemHealth Commercial |
$6,581.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,971.05
|
| Rate for Payer: Group Health Inc Commercial |
$17,971.05
|
| Rate for Payer: Group Health Inc Medicare |
$17,971.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,971.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,356.54
|
| Rate for Payer: Humana Medicare |
$24,710.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,971.05
|
| Rate for Payer: United Healthcare Commercial |
$15,263.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,971.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,971.05
|
| Rate for Payer: Wellcare Medicare |
$17,072.50
|
|
|
PATIENT PROGRAMMER, NEUROSTIM
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
40203159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.29 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,309.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.29
|
| Rate for Payer: Aetna Government |
$35.29
|
| Rate for Payer: Brighton Health Commercial |
$1,428.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,190.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,368.50
|
| Rate for Payer: EmblemHealth Commercial |
$1,190.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,499.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,190.00
|
| Rate for Payer: Group Health Inc Medicare |
$833.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,190.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,547.00
|
|
|
PATIENT PROGRAMMER, NEUROSTIM
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
40203159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.00 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,190.00
|
|
|
PATIENT SCREENING
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS D0190
|
| Hospital Charge Code |
42300708
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.80
|
| Rate for Payer: Aetna Government |
$10.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$47.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$47.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.21
|
| Rate for Payer: Amida Care Medicaid |
$21.21
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$2,121.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.27
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.21
|
| Rate for Payer: Healthfirst Essential Plan |
$47.72
|
| Rate for Payer: Healthfirst QHP |
$21.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.21
|
| Rate for Payer: SOMOS Essential |
$47.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$47.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$23.33
|
| Rate for Payer: United Healthcare Medicaid |
$21.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.21
|
|
|
PATIENT TRIAL KIT
|
Facility
|
OP
|
$2.50
|
|
| Hospital Charge Code |
64905858
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Brighton Health Commercial |
$1.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
|
|
PATTIES SURGICAL XEAY 1/2 X 3
|
Facility
|
OP
|
$0.74
|
|
| Hospital Charge Code |
40200613
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Brighton Health Commercial |
$0.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
|
|
PATTIES SURGICAL XRAY 1/2 X1/2
|
Facility
|
OP
|
$7.78
|
|
| Hospital Charge Code |
40200612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.89
|
| Rate for Payer: Aetna Government |
$3.89
|
| Rate for Payer: Brighton Health Commercial |
$5.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.29
|
| Rate for Payer: Group Health Inc Commercial |
$3.89
|
| Rate for Payer: Group Health Inc Medicare |
$2.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.89
|
|
|
PCI OF CTO ADD VESSEL W/DES
|
Facility
|
OP
|
$38,815.90
|
|
|
Service Code
|
HCPCS C9608
|
| Hospital Charge Code |
66526612
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$31,052.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,407.95
|
| Rate for Payer: Aetna Government |
$19,407.95
|
| Rate for Payer: Brighton Health Commercial |
$29,111.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,052.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,394.81
|
| Rate for Payer: Group Health Inc Commercial |
$19,407.95
|
| Rate for Payer: Group Health Inc Medicare |
$13,585.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,407.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,407.95
|
|
|
PCI OF CTO INITIAL VESSEL W/DES
|
Facility
|
OP
|
$38,815.90
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
66516611
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$14,194.60 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14,194.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14,194.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14,194.60
|
| Rate for Payer: Brighton Health Commercial |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,052.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,394.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$14,194.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$18,250.20
|
| Rate for Payer: Group Health Inc Medicare |
$18,250.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,407.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Humana Medicare |
$20,683.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
PCI OF CTO INITIAL VESSEL W/DES
|
Facility
|
IP
|
$38,815.90
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
66526611
|
|
Hospital Revenue Code
|
321
|
| Rate for Payer: Cash Price |
$20,278.00
|
|
|
PCI OF CTO INITIAL VESSEL W/DES
|
Facility
|
IP
|
$38,815.90
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
66516611
|
|
Hospital Revenue Code
|
321
|
| Rate for Payer: Cash Price |
$20,278.00
|
|
|
PCI OF CTO INITIAL VESSEL W/DES
|
Facility
|
OP
|
$38,815.90
|
|
|
Service Code
|
HCPCS C9607
|
| Hospital Charge Code |
66526611
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$14,194.60 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14,194.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14,194.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14,194.60
|
| Rate for Payer: Brighton Health Commercial |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,052.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,394.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$14,194.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$18,250.20
|
| Rate for Payer: Group Health Inc Medicare |
$18,250.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,407.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Humana Medicare |
$20,683.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
PCV 13
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
30305043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.00 |
| Max. Negotiated Rate |
$109.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
|
|
PCV 13
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
30305043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$273.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$241.38
|
| Rate for Payer: Aetna Government |
$241.38
|
| Rate for Payer: Brighton Health Commercial |
$130.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.35
|
| Rate for Payer: Group Health Inc Commercial |
$109.00
|
| Rate for Payer: Group Health Inc Medicare |
$76.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$273.47
|
| Rate for Payer: SOMOS Essential |
$273.47
|
| Rate for Payer: United Healthcare Commercial |
$257.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.70
|
|
|
PEAK FLOW METR EVALUATION BID
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
40306345
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
PEAK FLOW METR EVALUATION BID
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
40306345
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$383.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
PEAK FLOW METR EVALUATION Q2H
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
40306344
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
PEAK FLOW METR EVALUATION Q2H
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
40306344
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$383.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
PEAK FLOW METR EVALUATION Q3H
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
40306343
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
PEAK FLOW METR EVALUATION Q3H
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
40306343
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$383.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
PEAK FLOW METR EVALUATION Q4H
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
40306342
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
PEAK FLOW METR EVALUATION Q4H
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
40306342
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$383.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
PEAK FLOW METR EVALUATION Q6H
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
40306341
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$383.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
