|
SLCTV WND DEBRIDEM ADDL 20 CM/<
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97598
|
| Hospital Charge Code |
30300021
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.26
|
| Rate for Payer: Aetna Government |
$9.26
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.62
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
SLEEP EEG (SHORT DURATION)
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95822 TC
|
| Hospital Charge Code |
41003000
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$822.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
SLEEP EEG (SHORT DURATION)
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 95822 TC
|
| Hospital Charge Code |
41003000
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
SLEEP STUDY
|
Facility
|
IP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95805 TC
|
| Hospital Charge Code |
30305002
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
SLEEP STUDY
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95805 TC
|
| Hospital Charge Code |
30305002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$808.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| 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 |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$619.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
SLEEP STUDY, ATTENDED
|
Facility
|
IP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95807 TC
|
| Hospital Charge Code |
40401602
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
SLEEP STUDY, ATTENDED
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95807 TC
|
| Hospital Charge Code |
40401602
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$433.87 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$1,103.10
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
SLEEP STUDY, UNATTENDED
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95806 TC
|
| Hospital Charge Code |
30305453
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$2,342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$2,342.00
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
SLEEP STUDY, UNATTENDED
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 95806 TC
|
| Hospital Charge Code |
30305453
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
SLEEP STUDY UNATTENDED - HOME
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95800 TC
|
| Hospital Charge Code |
40402500
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$2,342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$2,342.00
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
SLEEP STUDY UNATTENDED - HOME
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 95800 TC
|
| Hospital Charge Code |
40402500
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
SLEEP STUDY, UNATTENDED W/ANAL
|
Facility
|
OP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95810 TC
|
| Hospital Charge Code |
30305445
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$1,514.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,514.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,209.08
|
| Rate for Payer: Aetna Government |
$1,209.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$846.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$846.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$846.36
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,209.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,209.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,027.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,076.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,209.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,076.08
|
| 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 |
$1,376.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,209.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,027.72
|
| Rate for Payer: Healthfirst QHP |
$1,209.08
|
| Rate for Payer: Humana Medicare |
$1,233.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,209.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,209.08
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,209.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,209.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$967.26
|
| Rate for Payer: Wellcare Medicare |
$1,148.63
|
|
|
SLEEP STUDY, UNATTENDED W/ANAL
|
Facility
|
IP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95810 TC
|
| Hospital Charge Code |
30305445
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,209.08
|
|
|
SLEEP STUDY UNATT&RESP EFFT
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95806 TC
|
| Hospital Charge Code |
40401601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$2,342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$2,342.00
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
SLEEP STUDY UNATT&RESP EFFT
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 95806 TC
|
| Hospital Charge Code |
40401601
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
SLEEVE 4 CM LGTH STR DIA 3/32
|
Facility
|
OP
|
$81.40
|
|
| Hospital Charge Code |
64906643
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$65.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.70
|
| Rate for Payer: Aetna Government |
$40.70
|
| Rate for Payer: Brighton Health Commercial |
$61.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.35
|
| Rate for Payer: Group Health Inc Commercial |
$40.70
|
| Rate for Payer: Group Health Inc Medicare |
$28.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.70
|
|
|
SLEEVE 4 CURVED 1CM NEEDLE
|
Facility
|
OP
|
$102.12
|
|
| Hospital Charge Code |
64906642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.06
|
| Rate for Payer: Aetna Government |
$51.06
|
| Rate for Payer: Brighton Health Commercial |
$76.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.44
|
| Rate for Payer: Group Health Inc Commercial |
$51.06
|
| Rate for Payer: Group Health Inc Medicare |
$35.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.06
|
|
|
SLEEVE ADAPTER
|
Facility
|
OP
|
$661.50
|
|
| Hospital Charge Code |
64907295
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$231.52 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$363.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$330.75
|
| Rate for Payer: Aetna Government |
$330.75
|
| Rate for Payer: Brighton Health Commercial |
$496.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$529.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$449.82
|
| Rate for Payer: Group Health Inc Commercial |
$330.75
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.75
|
|
|
SLEEVE CABLE MED VITALLIUM
|
Facility
|
OP
|
$1,280.25
|
|
| Hospital Charge Code |
64904430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$448.09 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$704.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$640.12
|
| Rate for Payer: Aetna Government |
$640.12
|
| Rate for Payer: Brighton Health Commercial |
$960.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,024.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$870.57
|
| Rate for Payer: Group Health Inc Commercial |
$640.12
|
| Rate for Payer: Group Health Inc Medicare |
$448.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$640.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$640.12
|
|
|
SLEEVE NAIL INSRT ELASTC 1407S
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
64906516
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$200.00
|
| Rate for Payer: Aetna Government |
$200.00
|
| Rate for Payer: Brighton Health Commercial |
$300.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$272.00
|
| Rate for Payer: Group Health Inc Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
|
SLEEVE PORT IRIS
|
Facility
|
OP
|
$18.29
|
|
| Hospital Charge Code |
64902472
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$14.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.14
|
| Rate for Payer: Aetna Government |
$9.14
|
| Rate for Payer: Brighton Health Commercial |
$13.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.44
|
| Rate for Payer: Group Health Inc Commercial |
$9.14
|
| Rate for Payer: Group Health Inc Medicare |
$6.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.14
|
|
|
SLEEVES INFUSION 0.9MM
|
Facility
|
OP
|
$312.50
|
|
| Hospital Charge Code |
64905016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.38 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.25
|
| Rate for Payer: Aetna Government |
$156.25
|
| Rate for Payer: Brighton Health Commercial |
$234.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$212.50
|
| Rate for Payer: Group Health Inc Commercial |
$156.25
|
| Rate for Payer: Group Health Inc Medicare |
$109.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.25
|
|
|
SLEEVE STERILE OR
|
Facility
|
OP
|
$1.80
|
|
| Hospital Charge Code |
64904238
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.90
|
| Rate for Payer: Aetna Government |
$0.90
|
| Rate for Payer: Brighton Health Commercial |
$1.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| 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
|
|
|
SLEEVE TISSUE
|
Facility
|
OP
|
$559.00
|
|
| Hospital Charge Code |
40202422
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.65 |
| Max. Negotiated Rate |
$447.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$307.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$279.50
|
| Rate for Payer: Aetna Government |
$279.50
|
| Rate for Payer: Brighton Health Commercial |
$419.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$447.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$380.12
|
| Rate for Payer: Group Health Inc Commercial |
$279.50
|
| Rate for Payer: Group Health Inc Medicare |
$195.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.50
|
|
|
SLEEVE UNITRAX V40 )MM STD
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$633.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$331.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$361.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$301.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$346.72
|
| Rate for Payer: EmblemHealth Commercial |
$301.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$633.15
|
| Rate for Payer: Group Health Inc Commercial |
$301.50
|
| Rate for Payer: Group Health Inc Medicare |
$211.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.95
|
|
