|
PUNCT DRAIN OF ABCESS LVL 1 I&D
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
30103211
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
PUNCT DRAIN OF ABCESS LVL 1 I&D
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
30103211
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$461.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
PUNCT DRAIN OF ABCESS LVL 1 I&D
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
30301182
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
PUNCT DRAIN OF ABCESS LVL 1 I&D
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
30301182
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
Puncture aspiration of abscess, hematoma, bulla, or cyst
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$322.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$461.12
|
| Rate for Payer: Group Health Inc Medicare |
$461.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
Puncture aspiration of cyst of breast;
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 19000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
PURAPLY PER 1 SQ CM
|
Facility
|
OP
|
$296.88
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
30300159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.91 |
| Max. Negotiated Rate |
$192.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$108.29
|
| Rate for Payer: Aetna Government |
$108.29
|
| Rate for Payer: Brighton Health Commercial |
$178.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$148.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.71
|
| Rate for Payer: Group Health Inc Commercial |
$148.44
|
| Rate for Payer: Group Health Inc Medicare |
$103.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.41
|
| Rate for Payer: SOMOS Essential |
$110.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.97
|
|
|
PURAPLY PER 1 SQ CM
|
Facility
|
IP
|
$296.88
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
30300159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$148.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.44
|
|
|
PURAPLY, PER SQ CM
|
Facility
|
IP
|
$296.88
|
|
|
Service Code
|
HCPCS Q4195
|
| Hospital Charge Code |
42500223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$148.44 |
| Max. Negotiated Rate |
$148.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.44
|
|
|
PURAPLY, PER SQ CM
|
Facility
|
OP
|
$296.88
|
|
|
Service Code
|
HCPCS Q4195
|
| Hospital Charge Code |
42500223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.91 |
| Max. Negotiated Rate |
$192.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.33
|
| Rate for Payer: Aetna Government |
$110.33
|
| Rate for Payer: Brighton Health Commercial |
$178.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$148.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.71
|
| Rate for Payer: Group Health Inc Commercial |
$148.44
|
| Rate for Payer: Group Health Inc Medicare |
$103.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.97
|
|
|
PURE TONE HEARING TEST AIR
|
Facility
|
OP
|
$82.22
|
|
|
Service Code
|
HCPCS 92551
|
| Hospital Charge Code |
30305686
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.97
|
| Rate for Payer: Aetna Government |
$10.97
|
| Rate for Payer: Brighton Health Commercial |
$61.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.91
|
| Rate for Payer: Group Health Inc Commercial |
$41.11
|
| Rate for Payer: Group Health Inc Medicare |
$28.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.11
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
|
|
PURE TONE STENGER TEST
|
Facility
|
IP
|
$101.25
|
|
|
Service Code
|
HCPCS 92565
|
| Hospital Charge Code |
42004504
|
|
Hospital Revenue Code
|
471
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
PURE TONE STENGER TEST
|
Facility
|
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 92565
|
| Hospital Charge Code |
42004504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$75.94
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
PURPLE DIALYZERS
|
Facility
|
OP
|
$58.12
|
|
| Hospital Charge Code |
42905320
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.06
|
| Rate for Payer: Aetna Government |
$29.06
|
| Rate for Payer: Brighton Health Commercial |
$43.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.52
|
| Rate for Payer: Group Health Inc Commercial |
$29.06
|
| Rate for Payer: Group Health Inc Medicare |
$20.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.06
|
|
|
PURSTRING
|
Facility
|
OP
|
$377.50
|
|
| Hospital Charge Code |
64902594
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.12 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$207.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.75
|
| Rate for Payer: Aetna Government |
$188.75
|
| Rate for Payer: Brighton Health Commercial |
$283.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$302.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$256.70
|
| Rate for Payer: Group Health Inc Commercial |
$188.75
|
| Rate for Payer: Group Health Inc Medicare |
$132.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.75
|
|
|
PURSTRING
|
Facility
|
OP
|
$153.54
|
|
| Hospital Charge Code |
40200618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.74 |
| Max. Negotiated Rate |
$122.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$76.77
|
| Rate for Payer: Aetna Government |
$76.77
|
| Rate for Payer: Brighton Health Commercial |
$115.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$122.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$104.41
|
| Rate for Payer: Group Health Inc Commercial |
$76.77
|
| Rate for Payer: Group Health Inc Medicare |
$53.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.77
|
|
|
PUSH G-TUBE 20FR.DOME
|
Facility
|
OP
|
$362.50
|
|
| Hospital Charge Code |
64905307
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$181.25
|
| Rate for Payer: Aetna Government |
$181.25
|
| Rate for Payer: Brighton Health Commercial |
$271.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$290.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$246.50
|
| Rate for Payer: Group Health Inc Commercial |
$181.25
|
| Rate for Payer: Group Health Inc Medicare |
$126.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.25
|
|
|
PUTTY, 10.0CC
|
Facility
|
OP
|
$6,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$6,713.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,516.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$3,836.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,197.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,676.55
|
| Rate for Payer: EmblemHealth Commercial |
$3,197.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,713.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,197.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,237.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,197.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,197.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,156.10
|
|
|
PUTTY, 10.0CC
|
Facility
|
IP
|
$4,504.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.04 |
| Max. Negotiated Rate |
$2,252.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,252.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,252.04
|
|
|
PUTTY, 10.0CC
|
Facility
|
OP
|
$4,504.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905391
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,729.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,477.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,702.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,252.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,589.85
|
| Rate for Payer: EmblemHealth Commercial |
$2,252.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,729.28
|
| Rate for Payer: Group Health Inc Commercial |
$2,252.04
|
| Rate for Payer: Group Health Inc Medicare |
$1,576.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,252.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,252.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,927.65
|
|
|
PUTTY, 10.0CC
|
Facility
|
IP
|
$6,394.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,197.00 |
| Max. Negotiated Rate |
$3,197.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,197.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,197.00
|
|
|
PUTTY, 1.0CC
|
Facility
|
IP
|
$1,071.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.99 |
| Max. Negotiated Rate |
$535.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$535.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$535.99
|
|
|
PUTTY, 1.0CC
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,654.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$866.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$945.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$788.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$906.20
|
| Rate for Payer: EmblemHealth Commercial |
$788.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,654.80
|
| Rate for Payer: Group Health Inc Commercial |
$788.00
|
| Rate for Payer: Group Health Inc Medicare |
$551.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$788.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$788.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,024.40
|
|
|
PUTTY, 1.0CC
|
Facility
|
IP
|
$1,576.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$788.00 |
| Max. Negotiated Rate |
$788.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$788.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$788.00
|
|
|
PUTTY, 1.0CC
|
Facility
|
OP
|
$1,071.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,125.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$589.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$643.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$535.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$616.39
|
| Rate for Payer: EmblemHealth Commercial |
$535.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,125.58
|
| Rate for Payer: Group Health Inc Commercial |
$535.99
|
| Rate for Payer: Group Health Inc Medicare |
$375.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$535.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$535.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$696.79
|
|
