|
UA DIP STICK
|
Facility
OP
|
$8.70
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
30301294
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.48
|
| Rate for Payer: EmblemHealth Commercial |
$3.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.48
|
| Rate for Payer: Healthfirst QHP |
$3.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.78
|
| Rate for Payer: Wellcare Medicare |
$3.13
|
|
|
UA MACRO
|
Facility
OP
|
$7.93
|
|
|
Service Code
|
HCPCS 81001
|
| Hospital Charge Code |
40626015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$5.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.17
|
| Rate for Payer: Aetna Government |
$3.17
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.17
|
| Rate for Payer: EmblemHealth Commercial |
$3.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.17
|
| Rate for Payer: Group Health Inc Medicare |
$3.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.17
|
| Rate for Payer: Healthfirst QHP |
$3.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.54
|
| Rate for Payer: Wellcare Medicare |
$2.85
|
|
|
UA,MICROSCOPY
|
Facility
OP
|
$10.05
|
|
|
Service Code
|
HCPCS 81000
|
| Hospital Charge Code |
30301319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.02
|
| Rate for Payer: Aetna Government |
$4.02
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.02
|
| Rate for Payer: EmblemHealth Commercial |
$4.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.58
|
| Rate for Payer: Group Health Inc Commercial |
$4.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.02
|
| Rate for Payer: Healthfirst QHP |
$4.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.22
|
| Rate for Payer: Wellcare Medicare |
$3.62
|
|
|
UCC
|
Facility
OP
|
$99.23
|
|
| Hospital Charge Code |
40206305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.62
|
| Rate for Payer: Aetna Government |
$49.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.48
|
| Rate for Payer: Group Health Inc Commercial |
$49.62
|
| Rate for Payer: Group Health Inc Medicare |
$34.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.62
|
|
|
UHR U BI/PLR COMP 44X28MM
|
Facility
IP
|
$3,070.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,535.00 |
| Max. Negotiated Rate |
$1,535.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,535.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,535.00
|
|
|
UHR U BI/PLR COMP 44X28MM
|
Facility
OP
|
$3,070.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205362
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,223.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,688.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,535.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,765.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,223.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,535.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,074.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,535.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,535.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,995.50
|
|
|
UHR UNI H BI/PLR COMP42MMX26MM
|
Facility
IP
|
$2,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,475.00 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,475.00
|
|
|
UHR UNI H BI/PLR COMP42MMX26MM
|
Facility
OP
|
$2,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,097.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,622.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,475.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,696.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,097.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,475.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,032.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,475.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,917.50
|
|
|
UHR UNIV BIPOLAR COMPO 50MMX28MM
|
Facility
IP
|
$2,268.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.00 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,134.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,134.00
|
|
|
UHR UNIV BIPOLAR COMPO 50MMX28MM
|
Facility
OP
|
$2,268.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,381.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,247.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,134.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,304.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,381.40
|
| Rate for Payer: Group Health Inc Commercial |
$1,134.00
|
| Rate for Payer: Group Health Inc Medicare |
$793.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,134.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,134.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,474.20
|
|
|
UHR UNIV HEAD BI/P COMP 41MMX26MM
|
Facility
OP
|
$3,010.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,160.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,655.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,505.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,730.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,160.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,053.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,956.50
|
|
|
UHR UNIV HEAD BI/P COMP 41MMX26MM
|
Facility
IP
|
$3,010.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$1,505.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
|
|
UHR UNIV HEAD BI/PLR CMP 48MMX28
|
Facility
IP
|
$2,836.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,418.00 |
| Max. Negotiated Rate |
$1,418.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,418.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,418.00
|
|
|
UHR UNIV HEAD BI/PLR CMP 48MMX28
|
Facility
OP
|
$2,836.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,977.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,559.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,418.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,630.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,977.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,418.00
|
| Rate for Payer: Group Health Inc Medicare |
$992.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,418.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,418.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,843.40
|
|
|
UHR UNIV HEAD BI/PLR COMP 45MMX28
|
Facility
IP
|
$3,010.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$1,505.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
|
|
UHR UNIV HEAD BI/PLR COMP 45MMX28
|
Facility
OP
|
$3,010.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205604
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,160.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,655.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,505.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,730.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,160.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,053.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,956.50
|
|
|
UHR UNVSL HEAD BIPLR COMP 43X26MM
|
Facility
OP
|
$2,140.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,247.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,177.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,070.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,230.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,247.84
|
| Rate for Payer: Group Health Inc Commercial |
$1,070.40
|
| Rate for Payer: Group Health Inc Medicare |
$749.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,070.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,070.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,391.52
|
|
|
UHR UNVSL HEAD BIPLR COMP 43X26MM
|
Facility
IP
|
$2,140.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209939
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.40 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,070.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,070.40
|
|
|
ULTRA,SCROTUM,PROS VOLBRACHYTXPLN
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76873 TC
|
| Hospital Charge Code |
66541306
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$110.45 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.45
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.72
|
|
|
ULTRASONIC GUIDE ASPIRATION OVA
|
Facility
OP
|
$346.84
|
|
|
Service Code
|
HCPCS 76948 TC
|
| Hospital Charge Code |
66541310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.68 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$190.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$173.42
|
| Rate for Payer: Aetna Government |
$173.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$277.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$235.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.68
|
| Rate for Payer: Group Health Inc Commercial |
$173.42
|
| Rate for Payer: Group Health Inc Medicare |
$121.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.75
|
|
|
ULTRASONIC NEBULZR TRTMNT
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40303000
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ULTRASONIC NEBULZR TRTMNT
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
30103248
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
IP
|
$77,026.65
|
|
|
Service Code
|
MS-DRG 278
|
| Min. Negotiated Rate |
$32,169.60 |
| Max. Negotiated Rate |
$77,026.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65,768.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69,181.93
|
| Rate for Payer: Aetna Government |
$69,181.93
|
| Rate for Payer: Brighton Health Commercial |
$64,675.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70,565.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77,026.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63,565.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$65,722.83
|
| Rate for Payer: EmblemHealth Commercial |
$38,247.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$69,181.93
|
| Rate for Payer: Group Health Inc Commercial |
$69,181.93
|
| Rate for Payer: Group Health Inc Medicare |
$69,181.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69,181.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32,169.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69,181.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69,181.93
|
| Rate for Payer: Wellcare Medicare |
$65,722.83
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
IP
|
$55,271.16
|
|
|
Service Code
|
MS-DRG 279
|
| Min. Negotiated Rate |
$24,045.99 |
| Max. Negotiated Rate |
$55,271.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47,192.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51,711.80
|
| Rate for Payer: Aetna Government |
$51,711.80
|
| Rate for Payer: Brighton Health Commercial |
$46,408.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52,746.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55,271.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$45,612.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$49,126.21
|
| Rate for Payer: EmblemHealth Commercial |
$27,445.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$51,711.80
|
| Rate for Payer: Group Health Inc Commercial |
$51,711.80
|
| Rate for Payer: Group Health Inc Medicare |
$51,711.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51,711.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24,045.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51,711.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51,711.80
|
| Rate for Payer: Wellcare Medicare |
$49,126.21
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
IP
|
$53,102.18
|
|
|
Service Code
|
MS-DRG 173
|
| Min. Negotiated Rate |
$23,236.06 |
| Max. Negotiated Rate |
$53,102.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45,340.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49,970.03
|
| Rate for Payer: Aetna Government |
$49,970.03
|
| Rate for Payer: Brighton Health Commercial |
$44,587.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50,969.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53,102.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43,822.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$47,471.53
|
| Rate for Payer: EmblemHealth Commercial |
$26,368.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$49,970.03
|
| Rate for Payer: Group Health Inc Commercial |
$49,970.03
|
| Rate for Payer: Group Health Inc Medicare |
$49,970.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49,970.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,236.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49,970.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49,970.03
|
| Rate for Payer: Wellcare Medicare |
$47,471.53
|
|
