|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$39,700.34
|
|
|
Service Code
|
MSDRG 082
|
| Min. Negotiated Rate |
$18,098.68 |
| Max. Negotiated Rate |
$39,700.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,593.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,921.90
|
| Rate for Payer: Aetna Government |
$38,921.90
|
| Rate for Payer: Brighton Health Commercial |
$33,035.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,700.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39,343.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,468.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,975.80
|
| Rate for Payer: EmblemHealth Commercial |
$19,536.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,921.90
|
| Rate for Payer: Group Health Inc Commercial |
$38,921.90
|
| Rate for Payer: Group Health Inc Medicare |
$38,921.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,921.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,098.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,921.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,921.90
|
| Rate for Payer: Wellcare Medicare |
$36,975.80
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$20,009.47
|
|
|
Service Code
|
MSDRG 087
|
| Min. Negotiated Rate |
$7,599.17 |
| Max. Negotiated Rate |
$20,009.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,067.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,617.13
|
| Rate for Payer: Aetna Government |
$19,617.13
|
| Rate for Payer: Brighton Health Commercial |
$12,849.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,009.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,303.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,629.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,636.27
|
| Rate for Payer: EmblemHealth Commercial |
$7,599.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,617.13
|
| Rate for Payer: Group Health Inc Commercial |
$19,617.13
|
| Rate for Payer: Group Health Inc Medicare |
$19,617.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,617.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,121.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,617.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,617.13
|
| Rate for Payer: Wellcare Medicare |
$18,636.27
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$20,483.31
|
|
|
Service Code
|
MSDRG 084
|
| Min. Negotiated Rate |
$7,886.43 |
| Max. Negotiated Rate |
$20,483.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,560.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,081.68
|
| Rate for Payer: Aetna Government |
$20,081.68
|
| Rate for Payer: Brighton Health Commercial |
$13,335.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,483.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,882.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,106.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,077.60
|
| Rate for Payer: EmblemHealth Commercial |
$7,886.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,081.68
|
| Rate for Payer: Group Health Inc Commercial |
$20,081.68
|
| Rate for Payer: Group Health Inc Medicare |
$20,081.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,081.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,337.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,081.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,081.68
|
| Rate for Payer: Wellcare Medicare |
$19,077.60
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$28,779.20
|
|
|
Service Code
|
MSDRG 604
|
| Min. Negotiated Rate |
$12,915.70 |
| Max. Negotiated Rate |
$28,779.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,208.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,214.90
|
| Rate for Payer: Aetna Government |
$28,214.90
|
| Rate for Payer: Brighton Health Commercial |
$21,839.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,779.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,010.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,465.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,804.16
|
| Rate for Payer: EmblemHealth Commercial |
$12,915.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,214.90
|
| Rate for Payer: Group Health Inc Commercial |
$28,214.90
|
| Rate for Payer: Group Health Inc Medicare |
$28,214.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,214.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,119.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,214.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,214.90
|
| Rate for Payer: Wellcare Medicare |
$26,804.16
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$20,329.12
|
|
|
Service Code
|
MSDRG 605
|
| Min. Negotiated Rate |
$7,792.96 |
| Max. Negotiated Rate |
$20,329.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,400.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,930.51
|
| Rate for Payer: Aetna Government |
$19,930.51
|
| Rate for Payer: Brighton Health Commercial |
$13,177.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,329.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,694.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,951.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,933.98
|
| Rate for Payer: EmblemHealth Commercial |
$7,792.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,930.51
|
| Rate for Payer: Group Health Inc Commercial |
$19,930.51
|
| Rate for Payer: Group Health Inc Medicare |
$19,930.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,930.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,267.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,930.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,930.51
|
| Rate for Payer: Wellcare Medicare |
$18,933.98
|
|
|
TRAVASOL 3.5% 1000CC
|
Facility
|
OP
|
$78.32
|
|
| Hospital Charge Code |
40509795
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$62.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.16
|
| Rate for Payer: Aetna Government |
$39.16
|
| Rate for Payer: Brighton Health Commercial |
$58.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.26
|
| Rate for Payer: Group Health Inc Commercial |
$39.16
|
| Rate for Payer: Group Health Inc Medicare |
$27.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.16
|
|
|
TRAVENNAL CASE
|
Facility
|
OP
|
$152.39
|
|
| Hospital Charge Code |
40206007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$121.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$76.20
|
| Rate for Payer: Aetna Government |
$76.20
|
| Rate for Payer: Brighton Health Commercial |
$114.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$121.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.63
|
| Rate for Payer: Group Health Inc Commercial |
$76.20
|
| Rate for Payer: Group Health Inc Medicare |
$53.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.20
|
|
|
TRAXI PANNICULUS RETRACTOR
|
Facility
|
OP
|
$168.75
|
|
| Hospital Charge Code |
64903750
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.06 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.38
|
| Rate for Payer: Aetna Government |
$84.38
|
| Rate for Payer: Brighton Health Commercial |
$126.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.75
|
| Rate for Payer: Group Health Inc Commercial |
$84.38
|
| Rate for Payer: Group Health Inc Medicare |
$59.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.38
|
|
|
TRAXI PANNICULUS RETRACTOR-EX
|
Facility
|
OP
|
$112.50
|
|
| Hospital Charge Code |
64903752
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.25
|
| Rate for Payer: Aetna Government |
$56.25
|
| Rate for Payer: Brighton Health Commercial |
$84.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.50
|
| Rate for Payer: Group Health Inc Commercial |
$56.25
|
| Rate for Payer: Group Health Inc Medicare |
$39.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.25
|
|
|
TRAY 18 GA. EPI HUSTEAD NEEDLE
|
Facility
|
OP
|
$47.70
|
|
| Hospital Charge Code |
64903802
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.85
|
| Rate for Payer: Aetna Government |
$23.85
|
| Rate for Payer: Brighton Health Commercial |
$35.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.44
|
| Rate for Payer: Group Health Inc Commercial |
$23.85
|
| Rate for Payer: Group Health Inc Medicare |
$16.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.85
|
|
|
TRAY AMNIOCENTESIS
|
Facility
|
OP
|
$31.50
|
|
| Hospital Charge Code |
64902428
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.75
|
| Rate for Payer: Aetna Government |
$15.75
|
| Rate for Payer: Brighton Health Commercial |
$23.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.42
|
| Rate for Payer: Group Health Inc Commercial |
$15.75
|
| Rate for Payer: Group Health Inc Medicare |
$11.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.75
|
|
|
TRAY ANGIO CVIR
|
Facility
|
OP
|
$126.33
|
|
| Hospital Charge Code |
64902514
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.22 |
| Max. Negotiated Rate |
$101.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.16
|
| Rate for Payer: Aetna Government |
$63.16
|
| Rate for Payer: Brighton Health Commercial |
$94.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$101.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.90
|
| Rate for Payer: Group Health Inc Commercial |
$63.16
|
| Rate for Payer: Group Health Inc Medicare |
$44.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.16
|
|
|
TRAY AV FISTULA/GRAFT INSERTION
|
Facility
|
OP
|
$133.71
|
|
| Hospital Charge Code |
64901356
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$106.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.86
|
| Rate for Payer: Aetna Government |
$66.86
|
| Rate for Payer: Brighton Health Commercial |
$100.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.92
|
| Rate for Payer: Group Health Inc Commercial |
$66.86
|
| Rate for Payer: Group Health Inc Medicare |
$46.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.86
|
|
|
TRAY BIOPSY CUSTOM
|
Facility
|
OP
|
$38.46
|
|
| Hospital Charge Code |
64901106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$30.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.23
|
| Rate for Payer: Aetna Government |
$19.23
|
| Rate for Payer: Brighton Health Commercial |
$28.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.15
|
| Rate for Payer: Group Health Inc Commercial |
$19.23
|
| Rate for Payer: Group Health Inc Medicare |
$13.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.23
|
|
|
TRAY BN MARROW BIOPSY W/4 15G NDL
|
Facility
|
OP
|
$71.96
|
|
| Hospital Charge Code |
64901690
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.98
|
| Rate for Payer: Aetna Government |
$35.98
|
| Rate for Payer: Brighton Health Commercial |
$53.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.93
|
| Rate for Payer: Group Health Inc Commercial |
$35.98
|
| Rate for Payer: Group Health Inc Medicare |
$25.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.98
|
|
|
TRAY CATH MAHURKAR 11.5X16
|
Facility
|
OP
|
$1,440.35
|
|
| Hospital Charge Code |
64902984
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$504.12 |
| Max. Negotiated Rate |
$1,152.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$792.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$720.18
|
| Rate for Payer: Aetna Government |
$720.18
|
| Rate for Payer: Brighton Health Commercial |
$1,080.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,152.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$979.44
|
| Rate for Payer: Group Health Inc Commercial |
$720.18
|
| Rate for Payer: Group Health Inc Medicare |
$504.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$720.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$720.18
|
|
|
TRAY CIRCUMCISION 1.1CM
|
Facility
|
OP
|
$91.25
|
|
| Hospital Charge Code |
64902447
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.62
|
| Rate for Payer: Aetna Government |
$45.62
|
| Rate for Payer: Brighton Health Commercial |
$68.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.05
|
| Rate for Payer: Group Health Inc Commercial |
$45.62
|
| Rate for Payer: Group Health Inc Medicare |
$31.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.62
|
|
|
TRAY CIRCUMCISION 1.3CM
|
Facility
|
OP
|
$91.25
|
|
| Hospital Charge Code |
64902445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.62
|
| Rate for Payer: Aetna Government |
$45.62
|
| Rate for Payer: Brighton Health Commercial |
$68.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.05
|
| Rate for Payer: Group Health Inc Commercial |
$45.62
|
| Rate for Payer: Group Health Inc Medicare |
$31.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.62
|
|
|
TRAY EPIDURAL CONTIN
|
Facility
|
OP
|
$48.55
|
|
| Hospital Charge Code |
64901718
|
|
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: Brighton Health Commercial |
$36.41
|
| 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
|
|
|
TRAY EPIDURAL SINGLE SHOT
|
Facility
|
OP
|
$4.01
|
|
| Hospital Charge Code |
64904746
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.73
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
|
|
TRAY FOLEY 16FR 5CC CATH L/F
|
Facility
|
OP
|
$34.57
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
64902552
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$27.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna Government |
$2.97
|
| Rate for Payer: Brighton Health Commercial |
$25.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.51
|
| Rate for Payer: Group Health Inc Commercial |
$17.28
|
| Rate for Payer: Group Health Inc Medicare |
$12.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.28
|
|
|
TRAY FOLEY 16FR 5CC CATH SIL
|
Facility
|
OP
|
$23.45
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
64902028
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$18.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna Government |
$2.97
|
| Rate for Payer: Brighton Health Commercial |
$17.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.95
|
| Rate for Payer: Group Health Inc Commercial |
$11.72
|
| Rate for Payer: Group Health Inc Medicare |
$8.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.72
|
|
|
TRAY FOLEY 18FR 5CC CATH SIL
|
Facility
|
OP
|
$23.45
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
64902025
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$18.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna Government |
$2.97
|
| Rate for Payer: Brighton Health Commercial |
$17.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.95
|
| Rate for Payer: Group Health Inc Commercial |
$11.72
|
| Rate for Payer: Group Health Inc Medicare |
$8.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.72
|
|
|
TRAY FOLEY 18FR 5CC SILICON L/F
|
Facility
|
OP
|
$27.21
|
|
| Hospital Charge Code |
64902554
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$21.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.60
|
| Rate for Payer: Aetna Government |
$13.60
|
| Rate for Payer: Brighton Health Commercial |
$20.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.50
|
| Rate for Payer: Group Health Inc Commercial |
$13.60
|
| Rate for Payer: Group Health Inc Medicare |
$9.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.60
|
|
|
TRAY FOLEY CATH SIL 18FR MTR
|
Facility
|
OP
|
$30.55
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
64902126
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna Government |
$2.97
|
| Rate for Payer: Brighton Health Commercial |
$22.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.77
|
| Rate for Payer: Group Health Inc Commercial |
$15.28
|
| Rate for Payer: Group Health Inc Medicare |
$10.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.28
|
|
