|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$25,627.36
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$6,993.77 |
| Max. Negotiated Rate |
$25,627.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,026.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,638.08
|
| Rate for Payer: Aetna Government |
$18,638.08
|
| Rate for Payer: Brighton Health Commercial |
$11,826.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,010.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,084.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,623.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,706.18
|
| Rate for Payer: EmblemHealth Commercial |
$6,993.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,638.08
|
| Rate for Payer: Group Health Inc Commercial |
$18,638.08
|
| Rate for Payer: Group Health Inc Medicare |
$18,638.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,638.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,666.71
|
| Rate for Payer: Humana Medicare |
$25,627.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,638.08
|
| Rate for Payer: United Healthcare Commercial |
$16,219.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,638.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,638.08
|
| Rate for Payer: Wellcare Medicare |
$17,706.18
|
|
|
PULMONARY STRESS COMPLEX
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 94621 TC
|
| Hospital Charge Code |
41701003
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
PULMONARY STRESS COMPLEX
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94621 TC
|
| Hospital Charge Code |
41701003
|
|
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
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 94618 TC
|
| Hospital Charge Code |
40402801
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$165.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
PULMONARY STRESS TESTING
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 94618 TC
|
| Hospital Charge Code |
40402801
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
PULMONEX AIR MATTRESS
|
Facility
|
OP
|
$184.28
|
|
| Hospital Charge Code |
40209248
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$147.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$92.14
|
| Rate for Payer: Aetna Government |
$92.14
|
| Rate for Payer: Brighton Health Commercial |
$138.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$125.31
|
| Rate for Payer: Group Health Inc Commercial |
$92.14
|
| Rate for Payer: Group Health Inc Medicare |
$64.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.14
|
|
|
PULPAL THERAPY(RESORB. FILL.) ANT
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS D3230
|
| Hospital Charge Code |
42303301
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
PULPAL THERAPY(RESORB. FILL.) ANT
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS D3230
|
| Hospital Charge Code |
42303301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$281.25
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
PULPAL THERAPY(RESORB FILL.) POST
|
Facility
|
OP
|
$587.50
|
|
|
Service Code
|
HCPCS D3240
|
| Hospital Charge Code |
42303302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.75 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$323.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$440.62
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
PULPAL THERAPY(RESORB FILL.) POST
|
Facility
|
IP
|
$587.50
|
|
|
Service Code
|
HCPCS D3240
|
| Hospital Charge Code |
42303302
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
PULP CAP-DIRECT (EXCLUDING FINAL
|
Facility
|
IP
|
$104.90
|
|
|
Service Code
|
HCPCS D3110
|
| Hospital Charge Code |
42300695
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
PULP CAP-DIRECT (EXCLUDING FINAL
|
Facility
|
OP
|
$104.90
|
|
|
Service Code
|
HCPCS D3110
|
| Hospital Charge Code |
42300695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$78.68
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
PULP CAP-INDIRECT (EXCLUDING FINA
|
Facility
|
IP
|
$102.06
|
|
|
Service Code
|
HCPCS D3120
|
| Hospital Charge Code |
42300700
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
PULP CAP-INDIRECT (EXCLUDING FINA
|
Facility
|
OP
|
$102.06
|
|
|
Service Code
|
HCPCS D3120
|
| Hospital Charge Code |
42300700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.03 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$76.54
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
PULP VITALITY TESTS
|
Facility
|
OP
|
$51.03
|
|
|
Service Code
|
HCPCS D0460
|
| Hospital Charge Code |
42300205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$38.27
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
PULP VITALITY TESTS
|
Facility
|
IP
|
$51.03
|
|
|
Service Code
|
HCPCS D0460
|
| Hospital Charge Code |
42300205
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
PULSE OX GRIP SPO2
|
Facility
|
OP
|
$17.60
|
|
| Hospital Charge Code |
64907387
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.80
|
| Rate for Payer: Aetna Government |
$8.80
|
| Rate for Payer: Brighton Health Commercial |
$13.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.97
|
| Rate for Payer: Group Health Inc Commercial |
$8.80
|
| Rate for Payer: Group Health Inc Medicare |
$6.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.80
|
|
|
PULSE OXIMETER, MULTIPLE DETERMIN
|
Facility
|
OP
|
$167.27
|
|
|
Service Code
|
HCPCS 94761
|
| Hospital Charge Code |
40301750
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$133.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.61
|
| Rate for Payer: Aetna Government |
$4.61
|
| Rate for Payer: Brighton Health Commercial |
$125.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.74
|
| Rate for Payer: Group Health Inc Commercial |
$83.64
|
| Rate for Payer: Group Health Inc Medicare |
$58.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.64
|
| Rate for Payer: United Healthcare Commercial |
$83.64
|
|
|
PULSE OXIMETER -SINGLE DETERMINAT
|
Facility
|
OP
|
$141.75
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
40307403
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$106.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$113.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.39
|
| Rate for Payer: Group Health Inc Commercial |
$70.88
|
| Rate for Payer: Group Health Inc Medicare |
$49.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.88
|
| Rate for Payer: United Healthcare Commercial |
$70.88
|
|
|
PULSE OXIMETER- SINGLE DETERMINAT
|
Facility
|
OP
|
$141.75
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
30103249
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$106.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$113.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.39
|
| Rate for Payer: Group Health Inc Commercial |
$70.88
|
| Rate for Payer: Group Health Inc Medicare |
$49.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.88
|
| Rate for Payer: United Healthcare Commercial |
$70.88
|
|
|
PUMP (72400098)
|
Facility
|
OP
|
$11,947.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64903859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.00 |
| Max. Negotiated Rate |
$12,544.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,571.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Brighton Health Commercial |
$7,168.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,973.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,869.81
|
| Rate for Payer: EmblemHealth Commercial |
$5,973.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,544.88
|
| Rate for Payer: Group Health Inc Commercial |
$5,973.75
|
| Rate for Payer: Group Health Inc Medicare |
$4,181.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,973.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,973.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,765.88
|
|
|
PUMP (72400098)
|
Facility
|
IP
|
$11,947.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64903859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,973.75 |
| Max. Negotiated Rate |
$5,973.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,973.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,973.75
|
|
|
PUMP BREAST MANUAL HYGENIC
|
Facility
|
OP
|
$45.53
|
|
| Hospital Charge Code |
64902435
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$36.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.76
|
| Rate for Payer: Aetna Government |
$22.76
|
| Rate for Payer: Brighton Health Commercial |
$34.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.96
|
| Rate for Payer: Group Health Inc Commercial |
$22.76
|
| Rate for Payer: Group Health Inc Medicare |
$15.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.76
|
|
|
PUMP, CONTROL IZ 800
|
Facility
|
OP
|
$13,037.50
|
|
| Hospital Charge Code |
64906064
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,563.12 |
| Max. Negotiated Rate |
$10,430.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,170.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,518.75
|
| Rate for Payer: Aetna Government |
$6,518.75
|
| Rate for Payer: Brighton Health Commercial |
$9,778.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10,430.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,865.50
|
| Rate for Payer: Group Health Inc Commercial |
$6,518.75
|
| Rate for Payer: Group Health Inc Medicare |
$4,563.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,518.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,518.75
|
|
|
PUMP IZ/PRE-CONNECTED (72404238)
|
Facility
|
IP
|
$21,585.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64905005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,792.50 |
| Max. Negotiated Rate |
$10,792.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,792.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,792.50
|
|
