|
BLEOMYCIN 15 UNITS INJ
|
Facility
IP
|
$31.08
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
41653829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$15.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.54
|
|
|
BLEOMYCIN 15 UNITS INJ
|
Facility
IP
|
$31.08
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
41643829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$15.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.54
|
|
|
BLEOMYCIN 15 UNITS INJ
|
Facility
OP
|
$31.08
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
41643829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.24
|
| Rate for Payer: Aetna Government |
$25.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.08
|
| Rate for Payer: Group Health Inc Commercial |
$15.54
|
| Rate for Payer: Group Health Inc Medicare |
$10.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.51
|
| Rate for Payer: SOMOS Essential |
$24.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.20
|
|
|
BLEOMYCIN 15 UNITS INJ
|
Facility
OP
|
$31.08
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
41653829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$25.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.24
|
| Rate for Payer: Aetna Government |
$25.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.08
|
| Rate for Payer: Group Health Inc Commercial |
$15.54
|
| Rate for Payer: Group Health Inc Medicare |
$10.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.51
|
| Rate for Payer: SOMOS Essential |
$24.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.20
|
|
|
BLEPHARATOMY DRAIN EYELID
|
Facility
OP
|
$819.25
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
30105941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$336.88
|
| Rate for Payer: Aetna Government |
$336.88
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$336.88
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.88
|
| 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 |
$336.88
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.82
|
| 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 |
$409.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$320.04
|
|
|
BLEPHAROTOMY DRAIN EYELID
|
Facility
OP
|
$819.25
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
30305941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$336.88
|
| Rate for Payer: Aetna Government |
$336.88
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$336.88
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.88
|
| 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 |
$336.88
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.82
|
| 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 |
$409.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$320.04
|
|
|
BLEPHEROPLASTY
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15820
|
| Hospital Charge Code |
40062310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$551.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$612.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
BLN SPL SPRINTER LEGEND
|
Facility
IP
|
$337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$168.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.75
|
|
|
BLN SPL SPRINTER LEGEND
|
Facility
OP
|
$337.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66520149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$354.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$185.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$194.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$354.38
|
| Rate for Payer: Group Health Inc Commercial |
$168.75
|
| Rate for Payer: Group Health Inc Medicare |
$118.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$219.38
|
|
|
BLOCK BITE ADJUSTABLE
|
Facility
OP
|
$1.12
|
|
| Hospital Charge Code |
64906821
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.56
|
| Rate for Payer: Aetna Government |
$0.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.76
|
| Rate for Payer: Group Health Inc Commercial |
$0.56
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
|
|
BLOCK BITE DISPOSABLE
|
Facility
OP
|
$11.38
|
|
| Hospital Charge Code |
40201034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.69
|
| Rate for Payer: Aetna Government |
$5.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.74
|
| Rate for Payer: Group Health Inc Commercial |
$5.69
|
| Rate for Payer: Group Health Inc Medicare |
$3.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.69
|
|
|
BLOCK BITE DISPOSABLE
|
Facility
OP
|
$6.38
|
|
| Hospital Charge Code |
64903957
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.19
|
| Rate for Payer: Aetna Government |
$3.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.34
|
| Rate for Payer: Group Health Inc Commercial |
$3.19
|
| Rate for Payer: Group Health Inc Medicare |
$2.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.19
|
|
|
BLOCKERS
|
Facility
OP
|
$792.43
|
|
| Hospital Charge Code |
64902872
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$277.35 |
| Max. Negotiated Rate |
$633.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$435.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$396.22
|
| Rate for Payer: Aetna Government |
$396.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$633.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$538.85
|
| Rate for Payer: Group Health Inc Commercial |
$396.22
|
| Rate for Payer: Group Health Inc Medicare |
$277.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.22
|
|
|
BLOCKERS HOWMEDICA
|
Facility
IP
|
$291.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40206066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.87 |
| Max. Negotiated Rate |
$145.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.87
|
|
|
BLOCKERS HOWMEDICA
|
Facility
OP
|
$291.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40206066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.11 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$160.46
|
| 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 |
$145.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$167.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$306.33
|
| Rate for Payer: Group Health Inc Commercial |
$145.87
|
| Rate for Payer: Group Health Inc Medicare |
$102.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.63
|
|
|
BLOCKER SPINAL 5MM
|
Facility
OP
|
$417.33
|
|
| Hospital Charge Code |
64901303
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$333.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$229.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$208.66
|
| Rate for Payer: Aetna Government |
$208.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$333.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$283.78
|
| Rate for Payer: Group Health Inc Commercial |
$208.66
|
| Rate for Payer: Group Health Inc Medicare |
$146.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.66
|
|
|
BLOCKER SPINAL REDUCTION
|
Facility
IP
|
$1,135.20
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
64904651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$567.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$567.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$567.60
|
|
|
BLOCKER SPINAL REDUCTION
|
Facility
OP
|
$1,135.20
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
64904651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.32 |
| Max. Negotiated Rate |
$2,494.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$624.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,494.69
|
| Rate for Payer: Aetna Government |
$2,494.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$567.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$652.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,191.96
|
| Rate for Payer: Group Health Inc Commercial |
$567.60
|
| Rate for Payer: Group Health Inc Medicare |
$397.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$567.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$567.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$737.88
|
|
|
BLOCK NEEDLE 20 GA X 6 SINGLE
|
Facility
OP
|
$905.25
|
|
| Hospital Charge Code |
64903812
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$316.84 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$497.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$452.62
|
| Rate for Payer: Aetna Government |
$452.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$724.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$615.57
|
| Rate for Payer: Group Health Inc Commercial |
$452.62
|
| Rate for Payer: Group Health Inc Medicare |
$316.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$452.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$452.62
|
|
|
BLOCK NEEDLE 21 GA X 4 SINGLE
|
Facility
OP
|
$714.53
|
|
| Hospital Charge Code |
64903810
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$250.09 |
| Max. Negotiated Rate |
$571.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$392.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$357.26
|
| Rate for Payer: Aetna Government |
$357.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$571.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$485.88
|
| Rate for Payer: Group Health Inc Commercial |
$357.26
|
| Rate for Payer: Group Health Inc Medicare |
$250.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$357.26
|
|
|
BLOCK NEEDLE 22 GA X 2 SINGLE
|
Facility
OP
|
$500.15
|
|
| Hospital Charge Code |
64903808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$400.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.08
|
| Rate for Payer: Aetna Government |
$250.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.10
|
| Rate for Payer: Group Health Inc Commercial |
$250.08
|
| Rate for Payer: Group Health Inc Medicare |
$175.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.08
|
|
|
BLOCK NEXGEN SZ F 10MM REV
|
Facility
OP
|
$5,498.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,773.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,024.30
|
| 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 |
$2,749.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,161.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,773.67
|
| Rate for Payer: Group Health Inc Commercial |
$2,749.36
|
| Rate for Payer: Group Health Inc Medicare |
$1,924.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,749.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,749.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,574.17
|
|
|
BLOCK NEXGEN SZ F 10MM REV
|
Facility
IP
|
$5,498.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906993
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,749.36 |
| Max. Negotiated Rate |
$2,749.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,749.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,749.36
|
|
|
BLOD TRAN.SET STERL VENUS PUN
|
Facility
OP
|
$14.53
|
|
| Hospital Charge Code |
40200630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.26
|
| Rate for Payer: Aetna Government |
$7.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: Group Health Inc Commercial |
$7.26
|
| Rate for Payer: Group Health Inc Medicare |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
BLOOD ALCOHOL (ETHANOL)
|
Facility
OP
|
$32.15
|
|
|
Service Code
|
HCPCS 80320
|
| Hospital Charge Code |
40602545
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$25.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.68
|
| 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 |
$25.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.86
|
| Rate for Payer: Group Health Inc Commercial |
$16.08
|
| Rate for Payer: Group Health Inc Medicare |
$11.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.08
|
|
