|
BIT DRILL TWIST 2.7MM DIA 125
|
Facility
IP
|
$262.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902541
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.25
|
|
|
BIT DRILL TWIST 2MM DIA 102MM
|
Facility
OP
|
$181.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.44 |
| Max. Negotiated Rate |
$190.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.69
|
| 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 |
$90.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$104.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$190.31
|
| Rate for Payer: Group Health Inc Commercial |
$90.62
|
| Rate for Payer: Group Health Inc Medicare |
$63.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.81
|
|
|
BIT DRILL TWIST 2MM DIA 102MM
|
Facility
IP
|
$181.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.62 |
| Max. Negotiated Rate |
$90.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.62
|
|
|
BIT DRILL TWIST 3.1MM DIA 285
|
Facility
OP
|
$385.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$211.75
|
| 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 |
$192.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$221.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$404.25
|
| Rate for Payer: Group Health Inc Commercial |
$192.50
|
| Rate for Payer: Group Health Inc Medicare |
$134.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.25
|
|
|
BIT DRILL TWIST 3.1MM DIA 285
|
Facility
IP
|
$385.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902632
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.50
|
|
|
BIT DRILL TWIST 3.2MM DIA SHO
|
Facility
OP
|
$307.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.62 |
| Max. Negotiated Rate |
$322.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$169.12
|
| 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 |
$153.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$322.88
|
| Rate for Payer: Group Health Inc Commercial |
$153.75
|
| Rate for Payer: Group Health Inc Medicare |
$107.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.88
|
|
|
BIT DRILL TWIST 3.2MM DIA SHO
|
Facility
IP
|
$307.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$153.75 |
| Max. Negotiated Rate |
$153.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.75
|
|
|
BIT DRILL TWIST 3.5MM DIA 4.8
|
Facility
OP
|
$201.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.44 |
| Max. Negotiated Rate |
$211.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.69
|
| 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 |
$100.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$211.31
|
| Rate for Payer: Group Health Inc Commercial |
$100.62
|
| Rate for Payer: Group Health Inc Medicare |
$70.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.81
|
|
|
BIT DRILL TWIST 3.5MM DIA 4.8
|
Facility
IP
|
$201.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.62 |
| Max. Negotiated Rate |
$100.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.62
|
|
|
BIT DRILL TWIST 3.5MM DIA STA
|
Facility
IP
|
$223.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$111.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.88
|
|
|
BIT DRILL TWIST 3.5MM DIA STA
|
Facility
OP
|
$223.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.31 |
| Max. Negotiated Rate |
$234.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.06
|
| 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 |
$111.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$128.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$234.94
|
| Rate for Payer: Group Health Inc Commercial |
$111.88
|
| Rate for Payer: Group Health Inc Medicare |
$78.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.44
|
|
|
Bite (Jawlock)
|
Facility
OP
|
$26.58
|
|
| Hospital Charge Code |
40200615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$21.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.29
|
| Rate for Payer: Aetna Government |
$13.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.07
|
| Rate for Payer: Group Health Inc Commercial |
$13.29
|
| Rate for Payer: Group Health Inc Medicare |
$9.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.29
|
|
|
BITEWINGS-FOUR FILMS
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
HCPCS D0274
|
| Hospital Charge Code |
42300155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| 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 |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
BITEWINGS-SINGLE FILM
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
HCPCS D0270
|
| Hospital Charge Code |
42300140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| 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 |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$105.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$105.08
|
| Rate for Payer: Group Health Inc Medicare |
$105.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.32
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
BITEWINGS - THREE FILMS
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
HCPCS D0273
|
| Hospital Charge Code |
42303417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| 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 |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
BITEWINGS-TWO FILMS
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
HCPCS D0272
|
| Hospital Charge Code |
42300145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| 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 |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$105.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$105.08
|
| Rate for Payer: Group Health Inc Medicare |
$105.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.32
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
BIT,T2 4.2X340 TRI FLAT DRILL
|
Facility
OP
|
$170.00
|
|
| Hospital Charge Code |
40005912
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.00
|
| Rate for Payer: Aetna Government |
$85.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.60
|
| Rate for Payer: Group Health Inc Commercial |
$85.00
|
| Rate for Payer: Group Health Inc Medicare |
$59.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.00
|
|
|
BIVALIRUDIN 250 MG INJ
|
Facility
OP
|
$0.90
|
|
| Hospital Charge Code |
41645612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
BIVALIRUDIN 250 MG INJ
|
Facility
IP
|
$0.90
|
|
| Hospital Charge Code |
41645612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
|
|
BIVALIRUDIN 250 MG INJ
|
Facility
OP
|
$0.90
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
41655612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Amida Care Medicaid |
$3.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.24
|
| Rate for Payer: Healthfirst Essential Plan |
$3.24
|
| Rate for Payer: Healthfirst QHP |
$3.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.24
|
| Rate for Payer: SOMOS Essential |
$3.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.24
|
|
|
BIVALIRUDIN 250 MG INJ
|
Facility
IP
|
$0.90
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
41655612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
|
|
BLADDER CARE SILICONE-16F
|
Facility
OP
|
$42.88
|
|
| Hospital Charge Code |
40207611
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$34.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.44
|
| Rate for Payer: Aetna Government |
$21.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.16
|
| Rate for Payer: Group Health Inc Commercial |
$21.44
|
| Rate for Payer: Group Health Inc Medicare |
$15.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.44
|
|
|
BLADDER CARE SILICONE-18F
|
Facility
OP
|
$42.88
|
|
| Hospital Charge Code |
40207612
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$34.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.44
|
| Rate for Payer: Aetna Government |
$21.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.16
|
| Rate for Payer: Group Health Inc Commercial |
$21.44
|
| Rate for Payer: Group Health Inc Medicare |
$15.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.44
|
|
|
BLADDER CARE TRAY
|
Facility
OP
|
$27.29
|
|
| Hospital Charge Code |
40207610
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.64
|
| Rate for Payer: Aetna Government |
$13.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.56
|
| Rate for Payer: Group Health Inc Commercial |
$13.64
|
| Rate for Payer: Group Health Inc Medicare |
$9.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.64
|
|
|
BLADDER FUNCTION TEST
|
Facility
OP
|
$1,770.90
|
|
|
Service Code
|
HCPCS 51728
|
| Hospital Charge Code |
30302527
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$789.96
|
| Rate for Payer: Aetna Government |
$789.96
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$789.96
|
| Rate for Payer: Cash Price |
$789.96
|
| Rate for Payer: Cash Price |
$789.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$789.96
|
| 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 |
$789.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$401.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$671.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$703.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$789.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$703.06
|
| 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 |
$885.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$789.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$445.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$671.47
|
| Rate for Payer: Healthfirst QHP |
$789.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$789.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$789.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$789.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$631.97
|
| Rate for Payer: Wellcare Medicare |
$750.46
|
|
