|
ZZ PEELAWAY SH 9 38 35
|
Facility
OP
|
$143.52
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
41567055
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$150.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.70
|
| Rate for Payer: Group Health Inc Commercial |
$71.76
|
| Rate for Payer: Group Health Inc Medicare |
$50.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.29
|
|
|
ZZ PERCLOSE PROGLIDE 6FRENCH
|
Facility
OP
|
$470.00
|
|
| Hospital Charge Code |
41569887
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$235.00
|
| Rate for Payer: Aetna Government |
$235.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$376.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$319.60
|
| Rate for Payer: Group Health Inc Commercial |
$235.00
|
| Rate for Payer: Group Health Inc Medicare |
$164.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
|
|
ZZ PET FDG PER 45MCI
|
Facility
OP
|
$310.00
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
41568739
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$260.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$170.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$260.79
|
| Rate for Payer: Aetna Government |
$260.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$248.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$210.80
|
| Rate for Payer: Group Health Inc Commercial |
$155.00
|
| Rate for Payer: Group Health Inc Medicare |
$108.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.00
|
|
|
ZZ PET N-13 AMMONIA PER 40MCI
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
HCPCS A9526
|
| Hospital Charge Code |
41568741
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$496.80
|
| Rate for Payer: Aetna Government |
$496.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.00
|
| Rate for Payer: Group Health Inc Commercial |
$275.00
|
| Rate for Payer: Group Health Inc Medicare |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.00
|
|
|
ZZ PETRI DISHES
|
Facility
OP
|
$278.12
|
|
| Hospital Charge Code |
41568877
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$139.06
|
| Rate for Payer: Aetna Government |
$139.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$222.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$189.12
|
| Rate for Payer: Group Health Inc Commercial |
$139.06
|
| Rate for Payer: Group Health Inc Medicare |
$97.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.06
|
|
|
ZZ PETRI DISHES
|
Facility
OP
|
$1,978.77
|
|
|
Service Code
|
HCPCS 77032
|
| Hospital Charge Code |
41568873
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$692.57 |
| Max. Negotiated Rate |
$1,583.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,088.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$989.38
|
| Rate for Payer: Aetna Government |
$989.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,583.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,345.56
|
| Rate for Payer: Group Health Inc Commercial |
$989.38
|
| Rate for Payer: Group Health Inc Medicare |
$692.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$989.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$989.38
|
|
|
ZZ PICC/4F/CV/60CM/CLAMPLESS
|
Facility
IP
|
$691.04
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.52 |
| Max. Negotiated Rate |
$345.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.52
|
|
|
ZZ PICC/4F/CV/60CM/CLAMPLESS
|
Facility
OP
|
$691.04
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569461
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$725.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$380.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna Government |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$345.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$397.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$725.59
|
| Rate for Payer: Group Health Inc Commercial |
$345.52
|
| Rate for Payer: Group Health Inc Medicare |
$241.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$449.18
|
|
|
ZZ PICC/4F/SINGLE LUMEN
|
Facility
OP
|
$114.48
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$120.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna Government |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.20
|
| Rate for Payer: Group Health Inc Commercial |
$57.24
|
| Rate for Payer: Group Health Inc Medicare |
$40.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.41
|
|
|
ZZ PICC/4F/SINGLE LUMEN
|
Facility
IP
|
$114.48
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$57.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.24
|
|
|
ZZ PICC DBL LUM 5FR
|
Facility
IP
|
$253.03
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$126.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.52
|
|
|
ZZ PICC DBL LUM 5FR
|
Facility
OP
|
$253.03
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569640
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$265.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna Government |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$126.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$145.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$265.68
|
| Rate for Payer: Group Health Inc Commercial |
$126.52
|
| Rate for Payer: Group Health Inc Medicare |
$88.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.47
|
|
|
ZZ PICC LINE/3F SINGLE LUMEN
|
Facility
OP
|
$114.48
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$120.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna Government |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.20
|
| Rate for Payer: Group Health Inc Commercial |
$57.24
|
| Rate for Payer: Group Health Inc Medicare |
$40.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.41
|
|
|
ZZ PICC LINE/3F SINGLE LUMEN
|
Facility
IP
|
$114.48
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$57.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.24
|
|
|
ZZ PICC LINE 4F/65 MORPH SINGLE
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
41568415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$110.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.00
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.00
|
|
|
ZZ PICC LINE 4F/65 MORPH SINGLE
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
41568415
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
|
|
ZZ PICC LINE/4F GROSHONG SINGLE
|
Facility
OP
|
$304.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$319.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$167.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna Government |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$174.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.26
|
| Rate for Payer: Group Health Inc Commercial |
$152.03
|
| Rate for Payer: Group Health Inc Medicare |
$106.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.64
|
|
|
ZZ PICC LINE/4F GROSHONG SINGLE
|
Facility
IP
|
$304.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.03 |
| Max. Negotiated Rate |
$152.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.03
|
|
|
ZZ PICC LINE/4F SINGLE LUMEN
|
Facility
IP
|
$114.48
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$57.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.24
|
|
|
ZZ PICC LINE/4F SINGLE LUMEN
|
Facility
OP
|
$114.48
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$120.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna Government |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.20
|
| Rate for Payer: Group Health Inc Commercial |
$57.24
|
| Rate for Payer: Group Health Inc Medicare |
$40.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.41
|
|
|
ZZ PICC LINE/5F GROSHONG DUBBLE
|
Facility
OP
|
$304.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$319.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$167.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna Government |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$174.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.26
|
| Rate for Payer: Group Health Inc Commercial |
$152.03
|
| Rate for Payer: Group Health Inc Medicare |
$106.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.64
|
|
|
ZZ PICC LINE/5F GROSHONG DUBBLE
|
Facility
IP
|
$304.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$152.03 |
| Max. Negotiated Rate |
$152.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.03
|
|
|
ZZ PICC LINE/5F SINGLE LUMEN
|
Facility
IP
|
$114.48
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$57.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.24
|
|
|
ZZ PICC LINE/5F SINGLE LUMEN
|
Facility
OP
|
$114.48
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
41569466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$120.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.08
|
| Rate for Payer: Aetna Government |
$7.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.20
|
| Rate for Payer: Group Health Inc Commercial |
$57.24
|
| Rate for Payer: Group Health Inc Medicare |
$40.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.41
|
|
|
ZZ PICC LINE 7F/65 MORPHEUS DUAL
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
41568416
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$110.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.00
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.00
|
|
