|
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structures
|
Facility
OP
|
$4,330.61
|
|
|
Service Code
|
CPT 31652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$230.49 |
| Max. Negotiated Rate |
$4,330.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,330.61
|
| Rate for Payer: Aetna Government |
$4,330.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,330.61
|
| 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 |
$4,330.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,681.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,854.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,330.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,854.24
|
| Rate for Payer: Group Health Inc Commercial |
$4,330.61
|
| Rate for Payer: Group Health Inc Medicare |
$4,330.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,330.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$256.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,681.02
|
| Rate for Payer: Healthfirst QHP |
$4,330.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,330.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,330.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,464.49
|
| Rate for Payer: Wellcare Medicare |
$4,114.08
|
|
|
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 31632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$76.99
|
| Rate for Payer: Aetna Government |
$76.99
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.41
|
|
|
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)
|
Facility
OP
|
$4,330.61
|
|
|
Service Code
|
CPT 31629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.56 |
| Max. Negotiated Rate |
$4,330.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,330.61
|
| Rate for Payer: Aetna Government |
$4,330.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,330.61
|
| 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 |
$4,330.61
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,681.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,854.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,330.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,854.24
|
| Rate for Payer: Group Health Inc Commercial |
$4,330.61
|
| Rate for Payer: Group Health Inc Medicare |
$4,330.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,330.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,681.02
|
| Rate for Payer: Healthfirst QHP |
$4,330.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,330.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,330.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,464.49
|
| Rate for Payer: Wellcare Medicare |
$4,114.08
|
|
|
BRONCHUS SAMPLING 3/> NODE
|
Facility
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31653
|
| Hospital Charge Code |
41543354
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.65 |
| Max. Negotiated Rate |
$4,447.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,330.61
|
| Rate for Payer: Aetna Government |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,330.61
|
| 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 |
$4,330.61
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,681.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,854.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,330.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,854.24
|
| Rate for Payer: Group Health Inc Commercial |
$4,330.61
|
| Rate for Payer: Group Health Inc Medicare |
$4,330.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,447.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,330.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,681.02
|
| Rate for Payer: Healthfirst QHP |
$4,330.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,330.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,330.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,464.49
|
| Rate for Payer: Wellcare Medicare |
$4,114.08
|
|
|
BRONCH W RX ANTIBX 30D
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2177
|
| Hospital Charge Code |
30300305
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
BRONCOSCOPY DX W/NEEDLE ASPR
|
Facility
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31629 TC
|
| Hospital Charge Code |
41102428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,892.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,892.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,447.59
|
| Rate for Payer: Aetna Government |
$4,447.59
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| 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: Group Health Inc Commercial |
$4,447.59
|
| Rate for Payer: Group Health Inc Medicare |
$3,113.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,447.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,447.59
|
|
|
BRONCOSCOPY DX W/WO BRUSHING
|
Facility
OP
|
$4,332.95
|
|
|
Service Code
|
HCPCS 31622 TC
|
| Hospital Charge Code |
41102422
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,516.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,383.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,166.48
|
| Rate for Payer: Aetna Government |
$2,166.48
|
| Rate for Payer: Cash Price |
$1,962.76
|
| Rate for Payer: Cash Price |
$1,962.76
|
| 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: Group Health Inc Commercial |
$2,166.48
|
| Rate for Payer: Group Health Inc Medicare |
$1,516.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,166.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,166.48
|
|
|
BRST RCNSTJ 1 PDCL TRAM FLAP
|
Facility
OP
|
$13,693.05
|
|
|
Service Code
|
HCPCS 19367
|
| Hospital Charge Code |
40062380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,531.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,531.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,560.46
|
| Rate for Payer: Aetna Government |
$1,560.46
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,987.39
|
| Rate for Payer: Group Health Inc Commercial |
$6,846.52
|
| Rate for Payer: Group Health Inc Medicare |
$4,792.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,846.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,846.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,208.21
|
|
|
BRST RCNSTJ FREE FLAP
|
Facility
OP
|
$13,693.05
|
|
|
Service Code
|
HCPCS 19364
|
| Hospital Charge Code |
40063225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,531.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,531.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,403.67
|
| Rate for Payer: Aetna Government |
$2,403.67
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,056.88
|
| Rate for Payer: Group Health Inc Commercial |
$6,846.52
|
| Rate for Payer: Group Health Inc Medicare |
$4,792.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,846.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,846.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,396.53
|
|
|
BRST RCNSTJ LATSMS DRSI FLAP
|
Facility
OP
|
$13,693.05
|
|
|
Service Code
|
HCPCS 19361
|
| Hospital Charge Code |
40063224
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,372.58 |
| Max. Negotiated Rate |
$7,531.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,531.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,372.58
|
| Rate for Payer: Aetna Government |
$1,372.58
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,751.10
|
| Rate for Payer: Group Health Inc Commercial |
$6,846.52
|
| Rate for Payer: Group Health Inc Medicare |
$4,792.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,846.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,846.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,945.67
|
|
|
BRST RCONSTJ 1 PDCL TRAM FLAP
|
Facility
OP
|
$13,693.05
|
|
|
Service Code
|
HCPCS 19367
|
| Hospital Charge Code |
40063229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,531.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,531.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,560.46
|
| Rate for Payer: Aetna Government |
$1,560.46
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,987.39
|
| Rate for Payer: Group Health Inc Commercial |
$6,846.52
|
| Rate for Payer: Group Health Inc Medicare |
$4,792.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,846.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,846.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,208.21
|
|
|
BRST RCONSTJ FREE FLAP
|
Facility
OP
|
$13,693.05
|
|
|
Service Code
|
HCPCS 19364
|
| Hospital Charge Code |
40019967
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,531.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,531.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,403.67
|
| Rate for Payer: Aetna Government |
$2,403.67
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,056.88
|
| Rate for Payer: Group Health Inc Commercial |
$6,846.52
|
| Rate for Payer: Group Health Inc Medicare |
$4,792.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,846.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,846.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,396.53
|
|
|
BRUCELLA ANTIBODY IGG/IGM
|
Facility
OP
|
$22.33
|
|
|
Service Code
|
HCPCS 86622
|
| Hospital Charge Code |
40729352
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$14.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.93
|
| Rate for Payer: Aetna Government |
$8.93
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.93
|
| Rate for Payer: EmblemHealth Commercial |
$8.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.95
|
| Rate for Payer: Group Health Inc Commercial |
$8.93
|
| Rate for Payer: Group Health Inc Medicare |
$8.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.93
|
| Rate for Payer: Healthfirst QHP |
$8.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.14
|
| Rate for Payer: Wellcare Medicare |
$8.04
|
|
|
BRUSH FEMORAL CANUAL
|
Facility
OP
|
$28.65
|
|
| Hospital Charge Code |
64903961
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.48
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$10.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.32
|
|
|
B.S. 100WX2.6MM LASER FIBER
|
Facility
OP
|
$1,560.00
|
|
| Hospital Charge Code |
40205624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$858.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$780.00
|
| Rate for Payer: Aetna Government |
$780.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,248.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,060.80
|
| Rate for Payer: Group Health Inc Commercial |
$780.00
|
| Rate for Payer: Group Health Inc Medicare |
$546.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$780.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$780.00
|
|
|
B.S. 4.8X26MM STENT ENDO PLUS
|
Facility
IP
|
$310.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
40205697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.00
|
|
|
B.S. 4.8X26MM STENT ENDO PLUS
|
Facility
OP
|
$310.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
40205697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$170.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.14
|
| Rate for Payer: Aetna Government |
$10.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$325.50
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.50
|
|
|
B.S. ALTURA 40 DDDR IS-1
|
Facility
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
40205838
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$10,500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,500.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,750.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,500.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,000.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,500.00
|
|
|
B.S. ALTURA 60 DDDR IS-1
|
Facility
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
40207042
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$11,550.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,050.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,325.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,550.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,500.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,850.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,500.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,150.00
|
|
|
B.S. ALTURA 60 P/M S606 DR EL
|
Facility
OP
|
$11,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
40205674
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$11,550.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,050.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,325.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,550.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,500.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,850.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,500.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,150.00
|
|
|
B.S. AMPLATZ SUPER STIFF ST TIP
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40206282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.00
|
|
|
B.S. AMPLATZ SUPER STIFF ST TIP
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40206282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.20
|
| Rate for Payer: Group Health Inc Commercial |
$42.00
|
| Rate for Payer: Group Health Inc Medicare |
$29.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.60
|
|
|
BS AMS700 LG 18 X 12
|
Facility
OP
|
$25,059.64
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40009999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.00 |
| Max. Negotiated Rate |
$26,312.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,782.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,529.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,409.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,312.62
|
| Rate for Payer: Group Health Inc Commercial |
$12,529.82
|
| Rate for Payer: Group Health Inc Medicare |
$8,770.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,529.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,529.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,288.77
|
|
|
BS AMS700 LG 18 X 12
|
Facility
IP
|
$25,059.64
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40009999
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,529.82 |
| Max. Negotiated Rate |
$12,529.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,529.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,529.82
|
|
|
B.S. ANGIOGRAPHIN CATH
|
Facility
OP
|
$65.50
|
|
| Hospital Charge Code |
40206286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$52.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.75
|
| Rate for Payer: Aetna Government |
$32.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.54
|
| Rate for Payer: Group Health Inc Commercial |
$32.75
|
| Rate for Payer: Group Health Inc Medicare |
$22.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.75
|
|
