|
ULTRASOUND OF HEAD AND NECK
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76506
|
| Hospital Charge Code |
30101101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.71 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$127.14
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| 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 |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
ULTRASOUND SCROTUM & CONTENTS
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76870
|
| Hospital Charge Code |
30107561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.71 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$127.14
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| 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 |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
Ultrasound, transrectal;
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 76872
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.71 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| 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 |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
ULTRASOUND TRANSRECTAL
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76872
|
| Hospital Charge Code |
30101102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.71 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$127.14
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| 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 |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
ULTRATHIN CATH BALLOON 5FR 6MM
|
Facility
OP
|
$370.00
|
|
| Hospital Charge Code |
40209783
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$203.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$185.00
|
| Rate for Payer: Aetna Government |
$185.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$296.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$251.60
|
| Rate for Payer: Group Health Inc Commercial |
$185.00
|
| Rate for Payer: Group Health Inc Medicare |
$129.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.00
|
|
|
UMBILICAL TAPE 36
|
Facility
OP
|
$4.62
|
|
| Hospital Charge Code |
64905663
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.31
|
| Rate for Payer: Aetna Government |
$2.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.14
|
| Rate for Payer: Group Health Inc Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Medicare |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.31
|
|
|
UMTB CANCELLOUS CRUSHED B/G 15CC
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$286.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$260.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$299.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$546.00
|
| Rate for Payer: Group Health Inc Commercial |
$260.00
|
| Rate for Payer: Group Health Inc Medicare |
$182.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$260.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$260.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$338.00
|
|
|
UMTB CANCELLOUS CRUSHED B/G 15CC
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205622
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$260.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$260.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$260.00
|
|
|
UMTB CANCELLOUS CRUSHED B/GFT10CC
|
Facility
OP
|
$687.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$721.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$378.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$343.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$395.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$721.88
|
| Rate for Payer: Group Health Inc Commercial |
$343.75
|
| Rate for Payer: Group Health Inc Medicare |
$240.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$343.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$343.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$446.88
|
|
|
UMTB CANCELLOUS CRUSHED B/GFT10CC
|
Facility
IP
|
$687.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$343.75 |
| Max. Negotiated Rate |
$343.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$343.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$343.75
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
IP
|
$27,251.55
|
|
|
Service Code
|
MS-DRG 383
|
| Min. Negotiated Rate |
$11,989.60 |
| Max. Negotiated Rate |
$27,251.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,616.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,717.21
|
| Rate for Payer: Aetna Government |
$26,717.21
|
| Rate for Payer: Brighton Health Commercial |
$20,273.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,251.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,145.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,925.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,381.35
|
| Rate for Payer: EmblemHealth Commercial |
$11,989.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,717.21
|
| Rate for Payer: Group Health Inc Commercial |
$26,717.21
|
| Rate for Payer: Group Health Inc Medicare |
$26,717.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,717.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,423.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,717.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,717.21
|
| Rate for Payer: Wellcare Medicare |
$25,381.35
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
IP
|
$19,860.93
|
|
|
Service Code
|
MS-DRG 384
|
| Min. Negotiated Rate |
$7,509.13 |
| Max. Negotiated Rate |
$19,860.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,912.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,471.50
|
| Rate for Payer: Aetna Government |
$19,471.50
|
| Rate for Payer: Brighton Health Commercial |
$12,697.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,860.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,122.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,479.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,497.92
|
| Rate for Payer: EmblemHealth Commercial |
$7,509.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,471.50
|
| Rate for Payer: Group Health Inc Commercial |
$19,471.50
|
| Rate for Payer: Group Health Inc Medicare |
$19,471.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,471.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,054.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,471.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,471.50
|
| Rate for Payer: Wellcare Medicare |
$18,497.92
|
|
|
UNDERPAD 23X24 FLUFF STD
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
64902117
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
|
|
UNDERPAD,PREMIUM,MVP 30 X 36
|
Facility
OP
|
$2.50
|
|
| Hospital Charge Code |
64902081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
|
|
UNDERPAD,WING,QUILTED 30X36
|
Facility
OP
|
$1.88
|
|
| Hospital Charge Code |
64902080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.94
|
| Rate for Payer: Aetna Government |
$0.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.94
|
| Rate for Payer: Group Health Inc Medicare |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.94
|
|
|
UNDERWATER DRAINAGE SET
|
Facility
OP
|
$32.60
|
|
| Hospital Charge Code |
40206310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.30
|
| Rate for Payer: Aetna Government |
$16.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.17
|
| Rate for Payer: Group Health Inc Commercial |
$16.30
|
| Rate for Payer: Group Health Inc Medicare |
$11.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.30
|
|
|
UNHLTHY ETOH RCVD COUNS
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2200
|
| Hospital Charge Code |
30300328
|
|
Hospital Revenue Code
|
929
|
| 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
|
|
|
UNIV BONE REP INSTRUMENT 3.2MM
|
Facility
OP
|
$700.00
|
|
| Hospital Charge Code |
40202158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$350.00
|
| Rate for Payer: Aetna Government |
$350.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$560.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$476.00
|
| Rate for Payer: Group Health Inc Commercial |
$350.00
|
| Rate for Payer: Group Health Inc Medicare |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
|
UNIVERSAL CATH ACCESS PORT STRL
|
Facility
OP
|
$79.26
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
40005182
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.10
|
| Rate for Payer: Aetna Government |
$3.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.90
|
| Rate for Payer: Group Health Inc Commercial |
$39.63
|
| Rate for Payer: Group Health Inc Medicare |
$27.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.63
|
|
|
UNIVERSAL CEMENT RES
|
Facility
OP
|
$500.00
|
|
| Hospital Charge Code |
64905808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.00
|
| Rate for Payer: Aetna Government |
$250.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
|
UNIVERSAL HEAD
|
Facility
OP
|
$2,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,097.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,622.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| 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
|
|
|
UNIVERSAL HEAD
|
Facility
OP
|
$2,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,247.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,177.00
|
| 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 |
$1,070.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,230.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,247.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,070.00
|
| Rate for Payer: Group Health Inc Medicare |
$749.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,070.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,070.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,391.00
|
|
|
UNIVERSAL HEAD
|
Facility
IP
|
$2,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.00 |
| Max. Negotiated Rate |
$1,070.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,070.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,070.00
|
|
|
UNIVERSAL HEAD
|
Facility
IP
|
$2,950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209870
|
|
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
|
|
|
UNIVERSAL HEAD BI POLAR
|
Facility
IP
|
$3,690.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,845.00 |
| Max. Negotiated Rate |
$1,845.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,845.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,845.00
|
|
