|
BAMLANIVIMAB-XXXX INFUSION
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0245
|
| Hospital Charge Code |
41650202
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
BAMLANIVIMAB-XXXX INFUSION
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0245
|
| Hospital Charge Code |
41650202
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
BANANA PEEL SHTH 11 15
|
Facility
OP
|
$146.72
|
|
| Hospital Charge Code |
41567059
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$117.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.36
|
| Rate for Payer: Aetna Government |
$73.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$117.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$99.77
|
| Rate for Payer: Group Health Inc Commercial |
$73.36
|
| Rate for Payer: Group Health Inc Medicare |
$51.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.36
|
|
|
BANDAGE 3 PLY
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40200603
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
BANDAGE ELASTIC 6 HONECOM BEIGE
|
Facility
OP
|
$113.00
|
|
| Hospital Charge Code |
64906242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$90.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.50
|
| Rate for Payer: Aetna Government |
$56.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.84
|
| Rate for Payer: Group Health Inc Commercial |
$56.50
|
| Rate for Payer: Group Health Inc Medicare |
$39.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.50
|
|
|
BANDAGE ESMARK 4X9
|
Facility
OP
|
$5.22
|
|
| Hospital Charge Code |
40201029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.61
|
| Rate for Payer: Aetna Government |
$2.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.55
|
| Rate for Payer: Group Health Inc Commercial |
$2.61
|
| Rate for Payer: Group Health Inc Medicare |
$1.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.61
|
|
|
BANDAGE ESMARK 6X9
|
Facility
OP
|
$7.30
|
|
| Hospital Charge Code |
40201030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.65
|
| Rate for Payer: Aetna Government |
$3.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.96
|
| Rate for Payer: Group Health Inc Commercial |
$3.65
|
| Rate for Payer: Group Health Inc Medicare |
$2.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.65
|
|
|
BANDAGE ESMARK STERILE 4X12
|
Facility
OP
|
$13.50
|
|
| Hospital Charge Code |
40201031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.75
|
| Rate for Payer: Aetna Government |
$6.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.18
|
| Rate for Payer: Group Health Inc Commercial |
$6.75
|
| Rate for Payer: Group Health Inc Medicare |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.75
|
|
|
BANDAGE FIBERGLSS ORTHOGLSS 3X15'
|
Facility
OP
|
$129.50
|
|
| Hospital Charge Code |
64902398
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$103.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.75
|
| Rate for Payer: Aetna Government |
$64.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$103.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.06
|
| Rate for Payer: Group Health Inc Commercial |
$64.75
|
| Rate for Payer: Group Health Inc Medicare |
$45.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.75
|
|
|
BANDAID STERILE 3/4 X 3
|
Facility
OP
|
$0.08
|
|
| Hospital Charge Code |
64901240
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
BANDAID STERILE 3/4X3
|
Facility
OP
|
$0.50
|
|
| Hospital Charge Code |
40209451
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
|
|
BANDAID TAZ BUGS BANDAIDS
|
Facility
OP
|
$0.08
|
|
| Hospital Charge Code |
64902433
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
BANDING OF HEMORRHOIDS
|
Facility
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
40019706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.74 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| Rate for Payer: Group Health Inc Commercial |
$1,056.92
|
| Rate for Payer: Group Health Inc Medicare |
$1,056.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.38
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
BANISH
|
Facility
OP
|
$14.53
|
|
| Hospital Charge Code |
40200671
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.26
|
| Rate for Payer: Aetna Government |
$7.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: Group Health Inc Commercial |
$7.26
|
| Rate for Payer: Group Health Inc Medicare |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
BANKART PROCEDURE
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 23455
|
| Hospital Charge Code |
40014303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,119.74 |
| Max. Negotiated Rate |
$9,058.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| 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 CHP/HARP/Medicaid |
$1,119.74
|
| 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 CHP/FHP/Medicaid |
$1,244.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health 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
|
|
|
BAR ARCH ERICH 1-METER ROLL
|
Facility
OP
|
$72.50
|
|
| Hospital Charge Code |
64904241
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$58.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.25
|
| Rate for Payer: Aetna Government |
$36.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.30
|
| Rate for Payer: Group Health Inc Commercial |
$36.25
|
| Rate for Payer: Group Health Inc Medicare |
$25.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.25
|
|
|
BARBITURATE CONFIRMATION, UR
|
Facility
OP
|
$88.95
|
|
|
Service Code
|
HCPCS 80345
|
| Hospital Charge Code |
40609017
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$71.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.49
|
| Rate for Payer: Group Health Inc Commercial |
$44.48
|
| Rate for Payer: Group Health Inc Medicare |
$31.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.48
|
|
|
BARBITURATE IDENTIFICATION
|
Facility
OP
|
$88.95
|
|
|
Service Code
|
HCPCS 80345
|
| Hospital Charge Code |
40602455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$71.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.49
|
| Rate for Payer: Group Health Inc Commercial |
$44.48
|
| Rate for Payer: Group Health Inc Medicare |
$31.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.48
|
|
|
BARD ABSORB FIXATION SYS
|
Facility
OP
|
$140.00
|
|
| Hospital Charge Code |
40205955
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.00
|
| Rate for Payer: Aetna Government |
$70.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.20
|
| Rate for Payer: Group Health Inc Commercial |
$70.00
|
| Rate for Payer: Group Health Inc Medicare |
$49.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
|
|
BARD ECLIPSE VENA CAVA FLTR FMRL
|
Facility
IP
|
$3,118.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
40205283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.00 |
| Max. Negotiated Rate |
$1,559.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,559.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,559.00
|
|
|
BARD ECLIPSE VENA CAVA FLTR FMRL
|
Facility
OP
|
$3,118.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
40205283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$3,273.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,714.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.08
|
| Rate for Payer: Aetna Government |
$57.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,559.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,792.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,273.90
|
| Rate for Payer: Group Health Inc Commercial |
$1,559.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,091.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,559.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,559.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,026.70
|
|
|
BARDEX HANGER
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40200605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
BARD MESH COMP. 4.2X6.2ELLIPSE
|
Facility
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40208079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$1,118.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$585.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$532.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$612.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,118.25
|
| Rate for Payer: Group Health Inc Commercial |
$532.50
|
| Rate for Payer: Group Health Inc Medicare |
$372.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$692.25
|
|
|
BARD MESH COMP. 4.2X6.2ELLIPSE
|
Facility
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40208079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.50
|
|
|
BARD MESH COMPOSIXL/P 8.2X10.2
|
Facility
OP
|
$3,286.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$3,450.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,807.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,643.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,889.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,450.30
|
| Rate for Payer: Group Health Inc Commercial |
$1,643.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,150.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,643.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,643.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,135.90
|
|
