|
POROUS STEM 11MMX135MM STD
|
Facility
|
OP
|
$8,122.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$8,528.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,467.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$4,873.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,061.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,670.15
|
| Rate for Payer: EmblemHealth Commercial |
$4,061.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,528.10
|
| Rate for Payer: Group Health Inc Commercial |
$4,061.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,842.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,061.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,061.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,279.30
|
|
|
POROUS STEM 11MMX135MM STD
|
Facility
|
IP
|
$8,122.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,061.00 |
| Max. Negotiated Rate |
$4,061.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,061.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,061.00
|
|
|
PORPHOBILINOGEN QN RANDOM UR
|
Facility
|
OP
|
$21.10
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
40609701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.44
|
| Rate for Payer: Aetna Government |
$8.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.91
|
| Rate for Payer: Brighton Health Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.44
|
| Rate for Payer: EmblemHealth Commercial |
$8.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.51
|
| Rate for Payer: Group Health Inc Commercial |
$8.44
|
| Rate for Payer: Group Health Inc Medicare |
$8.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.44
|
| Rate for Payer: Healthfirst QHP |
$8.44
|
| Rate for Payer: Humana Medicare |
$8.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.75
|
| Rate for Payer: Wellcare Medicare |
$7.60
|
|
|
PORPHOBILINOGEN QN RANDOM UR
|
Facility
|
IP
|
$21.10
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
40609701
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$8.44
|
|
|
PORPHOLBILINOGEN QUATITATION
|
Facility
|
OP
|
$21.10
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
40607285
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$15.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.44
|
| Rate for Payer: Aetna Government |
$8.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.91
|
| Rate for Payer: Brighton Health Commercial |
$15.82
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Cash Price |
$8.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.44
|
| Rate for Payer: EmblemHealth Commercial |
$8.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.51
|
| Rate for Payer: Group Health Inc Commercial |
$8.44
|
| Rate for Payer: Group Health Inc Medicare |
$8.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.44
|
| Rate for Payer: Healthfirst QHP |
$8.44
|
| Rate for Payer: Humana Medicare |
$8.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.75
|
| Rate for Payer: Wellcare Medicare |
$7.60
|
|
|
PORPHOLBILINOGEN QUATITATION
|
Facility
|
IP
|
$21.10
|
|
|
Service Code
|
HCPCS 84110
|
| Hospital Charge Code |
40607285
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$8.44
|
|
|
PORPHYRINS URINARY QUANTITATIO
|
Facility
|
OP
|
$36.78
|
|
|
Service Code
|
HCPCS 84120
|
| Hospital Charge Code |
40607459
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$27.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.71
|
| Rate for Payer: Aetna Government |
$14.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.30
|
| Rate for Payer: Brighton Health Commercial |
$27.58
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Cash Price |
$14.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.71
|
| Rate for Payer: EmblemHealth Commercial |
$14.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.09
|
| Rate for Payer: Group Health Inc Commercial |
$14.71
|
| Rate for Payer: Group Health Inc Medicare |
$14.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.71
|
| Rate for Payer: Healthfirst QHP |
$14.71
|
| Rate for Payer: Humana Medicare |
$15.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.71
|
| Rate for Payer: United Healthcare Commercial |
$18.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.77
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
|
|
PORPHYRINS URINARY QUANTITATIO
|
Facility
|
IP
|
$36.78
|
|
|
Service Code
|
HCPCS 84120
|
| Hospital Charge Code |
40607459
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$14.71
|
|
|
PORTABLE EEG
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 95822 TC
|
| Hospital Charge Code |
41006000
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
PORTABLE EEG
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95822 TC
|
| Hospital Charge Code |
41006000
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$822.00 |
| 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: 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 |
$822.00
|
| 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
|
|
|
PORTABLE SPIROMETRY
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 94010 TC
|
| Hospital Charge Code |
40402705
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$209.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
PORTABLE SPIROMETRY
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 94010 TC
|
| Hospital Charge Code |
40402705
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
PORT, ACCESS, CATH, UNIV, STERILE
|
Facility
|
OP
|
$99.08
|
|
| Hospital Charge Code |
64903936
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$79.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.54
|
| Rate for Payer: Aetna Government |
$49.54
|
| Rate for Payer: Brighton Health Commercial |
$74.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.37
|
| Rate for Payer: Group Health Inc Commercial |
$49.54
|
| Rate for Payer: Group Health Inc Medicare |
$34.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.54
|
|
|
PORT ASSEMBLY
|
Facility
|
OP
|
$56.25
|
|
| Hospital Charge Code |
64905526
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.12
|
| Rate for Payer: Aetna Government |
$28.12
|
| Rate for Payer: Brighton Health Commercial |
$42.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.25
|
| Rate for Payer: Group Health Inc Commercial |
$28.12
|
| Rate for Payer: Group Health Inc Medicare |
$19.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.12
|
|
|
PORT CLAMPS
|
Facility
|
OP
|
$9.92
|
|
| Hospital Charge Code |
42905250
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.96
|
| Rate for Payer: Aetna Government |
$4.96
|
| Rate for Payer: Brighton Health Commercial |
$7.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.75
|
| Rate for Payer: Group Health Inc Commercial |
$4.96
|
| Rate for Payer: Group Health Inc Medicare |
$3.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.96
|
|
|
PORTEX BIVONA 8 HYPER FLEX/FLANGE
|
Facility
|
OP
|
$375.42
|
|
| Hospital Charge Code |
40206227
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$300.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$187.71
|
| Rate for Payer: Aetna Government |
$187.71
|
| Rate for Payer: Brighton Health Commercial |
$281.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.29
|
| Rate for Payer: Group Health Inc Commercial |
$187.71
|
| Rate for Payer: Group Health Inc Medicare |
$131.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.71
|
|
|
PORTEX TUBE TRACH CUFFED
|
Facility
|
OP
|
$55.20
|
|
| Hospital Charge Code |
40205067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.60
|
| Rate for Payer: Aetna Government |
$27.60
|
| Rate for Payer: Brighton Health Commercial |
$41.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.54
|
| Rate for Payer: Group Health Inc Commercial |
$27.60
|
| Rate for Payer: Group Health Inc Medicare |
$19.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.60
|
|
|
PORTEX TUBE XL HYPERFLEX
|
Facility
|
OP
|
$217.06
|
|
| Hospital Charge Code |
40206288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.97 |
| Max. Negotiated Rate |
$173.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$108.53
|
| Rate for Payer: Aetna Government |
$108.53
|
| Rate for Payer: Brighton Health Commercial |
$162.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$147.60
|
| Rate for Payer: Group Health Inc Commercial |
$108.53
|
| Rate for Payer: Group Health Inc Medicare |
$75.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.53
|
|
|
PORTO-VAC WOUND SUCTION
|
Facility
|
OP
|
$45.36
|
|
| Hospital Charge Code |
40000305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$36.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.68
|
| Rate for Payer: Aetna Government |
$22.68
|
| Rate for Payer: Brighton Health Commercial |
$34.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.84
|
| Rate for Payer: Group Health Inc Commercial |
$22.68
|
| Rate for Payer: Group Health Inc Medicare |
$15.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.68
|
|
|
PORT Y-STYLE FEEDING 20FR PERCUTA
|
Facility
|
OP
|
$21.73
|
|
| Hospital Charge Code |
64904376
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.86
|
| Rate for Payer: Aetna Government |
$10.86
|
| Rate for Payer: Brighton Health Commercial |
$16.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.78
|
| Rate for Payer: Group Health Inc Commercial |
$10.86
|
| Rate for Payer: Group Health Inc Medicare |
$7.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.86
|
|
|
POS CLIN DEPRES SCRN F/U DOC
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8431
|
| Hospital Charge Code |
30307866
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
POSEY PELVIC RESTRAINT(DIAPR)
|
Facility
|
OP
|
$65.21
|
|
| Hospital Charge Code |
40204838
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.60
|
| Rate for Payer: Aetna Government |
$32.60
|
| Rate for Payer: Brighton Health Commercial |
$48.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.34
|
| Rate for Payer: Group Health Inc Commercial |
$32.60
|
| Rate for Payer: Group Health Inc Medicare |
$22.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.60
|
|
|
POST 2-HOLE
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.00
|
|
|
POST 2-HOLE
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$168.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$140.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.00
|
| Rate for Payer: EmblemHealth Commercial |
$140.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$140.00
|
| Rate for Payer: Group Health Inc Medicare |
$98.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.00
|
|
|
POST AMNIOCENTESIS
|
Facility
|
OP
|
$177.19
|
|
| Hospital Charge Code |
40250600
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$62.02 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$88.60
|
| Rate for Payer: Aetna Government |
$88.60
|
| Rate for Payer: Brighton Health Commercial |
$132.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$141.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.49
|
| Rate for Payer: Group Health Inc Commercial |
$88.60
|
| Rate for Payer: Group Health Inc Medicare |
$62.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.60
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
|
