|
ZZ OCCLU BAL CTH 5/2/100
|
Facility
OP
|
$440.14
|
|
| Hospital Charge Code |
41567217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$352.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$242.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$220.07
|
| Rate for Payer: Aetna Government |
$220.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$352.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$299.30
|
| Rate for Payer: Group Health Inc Commercial |
$220.07
|
| Rate for Payer: Group Health Inc Medicare |
$154.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.07
|
|
|
ZZ OCCLU BAL CTH 7/2/100
|
Facility
OP
|
$440.14
|
|
| Hospital Charge Code |
41567218
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.05 |
| Max. Negotiated Rate |
$352.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$242.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$220.07
|
| Rate for Payer: Aetna Government |
$220.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$352.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$299.30
|
| Rate for Payer: Group Health Inc Commercial |
$220.07
|
| Rate for Payer: Group Health Inc Medicare |
$154.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.07
|
|
|
ZZ OCCLU BALL CTH 8/2/100
|
Facility
OP
|
$472.74
|
|
| Hospital Charge Code |
41567219
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.46 |
| Max. Negotiated Rate |
$378.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$260.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$236.37
|
| Rate for Payer: Aetna Government |
$236.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$378.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$321.46
|
| Rate for Payer: Group Health Inc Commercial |
$236.37
|
| Rate for Payer: Group Health Inc Medicare |
$165.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.37
|
|
|
ZZ OLBERT BAL 7-4/5.8/90
|
Facility
OP
|
$635.75
|
|
| Hospital Charge Code |
41567273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.51 |
| Max. Negotiated Rate |
$508.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$317.88
|
| Rate for Payer: Aetna Government |
$317.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$508.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.31
|
| Rate for Payer: Group Health Inc Commercial |
$317.88
|
| Rate for Payer: Group Health Inc Medicare |
$222.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.88
|
|
|
ZZ OLBERT BAL 7-4/6/90
|
Facility
OP
|
$586.85
|
|
| Hospital Charge Code |
41567274
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$469.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$322.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.42
|
| Rate for Payer: Aetna Government |
$293.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$469.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$399.06
|
| Rate for Payer: Group Health Inc Commercial |
$293.42
|
| Rate for Payer: Group Health Inc Medicare |
$205.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.42
|
|
|
ZZ OLBERT BAL 8-4/5.8/90
|
Facility
OP
|
$635.75
|
|
| Hospital Charge Code |
41567271
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.51 |
| Max. Negotiated Rate |
$508.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$317.88
|
| Rate for Payer: Aetna Government |
$317.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$508.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.31
|
| Rate for Payer: Group Health Inc Commercial |
$317.88
|
| Rate for Payer: Group Health Inc Medicare |
$222.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.88
|
|
|
ZZ OLBERT BAL 9-4/7/90
|
Facility
OP
|
$635.75
|
|
| Hospital Charge Code |
41567270
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.51 |
| Max. Negotiated Rate |
$508.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$317.88
|
| Rate for Payer: Aetna Government |
$317.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$508.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.31
|
| Rate for Payer: Group Health Inc Commercial |
$317.88
|
| Rate for Payer: Group Health Inc Medicare |
$222.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.88
|
|
|
ZZ OLBERT BALL 10-4/7.8/90
|
Facility
OP
|
$635.75
|
|
| Hospital Charge Code |
41567269
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.51 |
| Max. Negotiated Rate |
$508.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$317.88
|
| Rate for Payer: Aetna Government |
$317.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$508.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.31
|
| Rate for Payer: Group Health Inc Commercial |
$317.88
|
| Rate for Payer: Group Health Inc Medicare |
$222.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.88
|
|
|
ZZ OLBERT BALL 12-4/7.5/90
|
Facility
OP
|
$652.05
|
|
| Hospital Charge Code |
41567268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$228.22 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$358.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$326.02
|
| Rate for Payer: Aetna Government |
$326.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$521.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$443.39
|
| Rate for Payer: Group Health Inc Commercial |
$326.02
|
| Rate for Payer: Group Health Inc Medicare |
$228.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$326.02
|
|
|
ZZ OLBERT BALL 5-4/5.8/90
|
Facility
OP
|
$635.75
|
|
| Hospital Charge Code |
41567275
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.51 |
| Max. Negotiated Rate |
$508.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$317.88
|
| Rate for Payer: Aetna Government |
$317.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$508.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.31
|
| Rate for Payer: Group Health Inc Commercial |
$317.88
|
| Rate for Payer: Group Health Inc Medicare |
$222.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.88
|
|
|
ZZ OLBERT BALL 7-2.5/5.8/90
|
Facility
OP
|
$635.75
|
|
| Hospital Charge Code |
41567272
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.51 |
| Max. Negotiated Rate |
$508.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$317.88
|
| Rate for Payer: Aetna Government |
$317.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$508.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.31
|
| Rate for Payer: Group Health Inc Commercial |
$317.88
|
| Rate for Payer: Group Health Inc Medicare |
$222.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.88
|
|
|
ZZ OMNIFLUSH CATHETER 4
|
Facility
OP
|
$48.55
|
|
| Hospital Charge Code |
41567168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$38.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.28
|
| Rate for Payer: Aetna Government |
$24.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.01
|
| Rate for Payer: Group Health Inc Commercial |
$24.28
|
| Rate for Payer: Group Health Inc Medicare |
$16.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.28
|
|
|
ZZ OMNIFLUSH CATHETER 5
|
Facility
OP
|
$48.55
|
|
| Hospital Charge Code |
41567167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$38.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.28
|
| Rate for Payer: Aetna Government |
$24.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.01
|
| Rate for Payer: Group Health Inc Commercial |
$24.28
|
| Rate for Payer: Group Health Inc Medicare |
$16.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.28
|
|
|
ZZ OMNIPAQUE 300/100ML PER ML
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
41563111
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ZZ OMNIPAQUE 300/150ML PER ML
|
Facility
OP
|
$1.80
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
41563110
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.17
|
|
|
ZZ OMNIPAQUE 350/150ML - PER ML
|
Facility
OP
|
$1.80
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
41563108
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.12
|
| Rate for Payer: Aetna Government |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.90
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.17
|
|
|
ZZ OMNISCAN 10ML (GAD) INJ-PERML
|
Facility
OP
|
$42.50
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
41565952
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna Government |
$1.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.39
|
| Rate for Payer: Group Health Inc Commercial |
$21.25
|
| Rate for Payer: Group Health Inc Medicare |
$14.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.62
|
|
|
ZZ OMNISCAN 15ML (GAD) INJ-PER ML
|
Facility
OP
|
$63.75
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
41565951
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna Government |
$1.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.39
|
| Rate for Payer: Group Health Inc Commercial |
$31.88
|
| Rate for Payer: Group Health Inc Medicare |
$22.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.44
|
|
|
ZZ OMNISCAN 20ML (GAD) INJ
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
41565950
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna Government |
$1.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.39
|
| Rate for Payer: Group Health Inc Commercial |
$42.50
|
| Rate for Payer: Group Health Inc Medicare |
$29.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.25
|
|
|
ZZ ONCONTROL BONE NEEDLE SET
|
Facility
OP
|
$1,140.00
|
|
| Hospital Charge Code |
41564623
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$627.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$570.00
|
| Rate for Payer: Aetna Government |
$570.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$912.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$775.20
|
| Rate for Payer: Group Health Inc Commercial |
$570.00
|
| Rate for Payer: Group Health Inc Medicare |
$399.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$570.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$570.00
|
|
|
ZZ ONCONTROL SYS PROC TRAY
|
Facility
OP
|
$600.00
|
|
| Hospital Charge Code |
41564621
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.00
|
| Rate for Payer: Aetna Government |
$300.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
|
|
ZZ ONEWAY STOPCOC FLL/MLL
|
Facility
OP
|
$87.89
|
|
| Hospital Charge Code |
41567302
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.94
|
| Rate for Payer: Aetna Government |
$43.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.77
|
| Rate for Payer: Group Health Inc Commercial |
$43.94
|
| Rate for Payer: Group Health Inc Medicare |
$30.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.94
|
|
|
ZZ ORTHOVITA 3 TIPS LUER
|
Facility
OP
|
$600.00
|
|
| Hospital Charge Code |
41563102
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.00
|
| Rate for Payer: Aetna Government |
$300.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
|
|
ZZ ORTHOVITA CARTRIDGE 5 CC
|
Facility
OP
|
$2,000.00
|
|
| Hospital Charge Code |
41563103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,100.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,000.00
|
| Rate for Payer: Aetna Government |
$1,000.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,360.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,000.00
|
|
|
ZZ ORTHOVITA DELIVERY GUN
|
Facility
OP
|
$1,100.00
|
|
| Hospital Charge Code |
41563101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$605.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$550.00
|
| Rate for Payer: Aetna Government |
$550.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$880.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$748.00
|
| Rate for Payer: Group Health Inc Commercial |
$550.00
|
| Rate for Payer: Group Health Inc Medicare |
$385.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$550.00
|
|
