|
CANCER 27.29
|
Facility
OP
|
$52.03
|
|
|
Service Code
|
HCPCS 86316
|
| Hospital Charge Code |
40728132
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$33.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.65
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
CANCER ANTIGEN (CA) 125
|
Facility
OP
|
$52.03
|
|
|
Service Code
|
HCPCS 86304
|
| Hospital Charge Code |
40609143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$33.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.65
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
CANCER ANTIGEN (CA) 15-3
|
Facility
OP
|
$52.03
|
|
|
Service Code
|
HCPCS 86300
|
| Hospital Charge Code |
40609141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$33.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.81
|
| Rate for Payer: Aetna Government |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.81
|
| Rate for Payer: EmblemHealth Commercial |
$20.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Group Health Inc Commercial |
$20.81
|
| Rate for Payer: Group Health Inc Medicare |
$20.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.81
|
| Rate for Payer: Healthfirst QHP |
$20.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.65
|
| Rate for Payer: Wellcare Medicare |
$18.73
|
|
|
CANDESARTAN 16 MG TAB
|
Facility
OP
|
$5.03
|
|
| Hospital Charge Code |
41643008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.52
|
| Rate for Payer: Aetna Government |
$2.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.42
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.27
|
|
|
CANDESARTAN 16 MG TAB
|
Facility
OP
|
$5.03
|
|
| Hospital Charge Code |
41653008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.52
|
| Rate for Payer: Aetna Government |
$2.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.42
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.27
|
|
|
CANDESARTAN 4 MG TAB
|
Facility
OP
|
$5.04
|
|
| Hospital Charge Code |
41644636
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.52
|
| Rate for Payer: Aetna Government |
$2.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.43
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
|
|
CANDESARTAN 4 MG TAB
|
Facility
OP
|
$5.04
|
|
| Hospital Charge Code |
41654636
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.52
|
| Rate for Payer: Aetna Government |
$2.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.43
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
|
|
CANDESARTAN 8 MG TAB
|
Facility
OP
|
$5.04
|
|
| Hospital Charge Code |
41654815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.52
|
| Rate for Payer: Aetna Government |
$2.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.43
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
|
|
CANDESARTAN 8 MG TAB
|
Facility
OP
|
$5.04
|
|
| Hospital Charge Code |
41644815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.52
|
| Rate for Payer: Aetna Government |
$2.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.43
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
|
|
CANDO VESTIBULAR DISC 60CM 23.6
|
Facility
OP
|
$99.98
|
|
| Hospital Charge Code |
64903311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$79.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.99
|
| Rate for Payer: Aetna Government |
$49.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.99
|
| Rate for Payer: Group Health Inc Commercial |
$49.99
|
| Rate for Payer: Group Health Inc Medicare |
$34.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.99
|
|
|
CANISTER 2500C 2-ELBOW
|
Facility
OP
|
$7.81
|
|
| Hospital Charge Code |
64902042
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.90
|
| Rate for Payer: Aetna Government |
$3.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.31
|
| Rate for Payer: Group Health Inc Commercial |
$3.90
|
| Rate for Payer: Group Health Inc Medicare |
$2.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.90
|
|
|
CANISTER ABTHERA 1000ML
|
Facility
OP
|
$25.88
|
|
| Hospital Charge Code |
64901527
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.94
|
| Rate for Payer: Aetna Government |
$12.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.60
|
| Rate for Payer: Group Health Inc Commercial |
$12.94
|
| Rate for Payer: Group Health Inc Medicare |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.94
|
|
|
CANISTER INDIGO SYSTEM
|
Facility
OP
|
$720.00
|
|
| Hospital Charge Code |
64906846
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$396.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.00
|
| Rate for Payer: Aetna Government |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$576.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$489.60
|
| Rate for Payer: Group Health Inc Commercial |
$360.00
|
| Rate for Payer: Group Health Inc Medicare |
$252.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$360.00
|
|
|
CANISTER SUCTION 1200CC SEP-T-VAC
|
Facility
OP
|
$5.28
|
|
| Hospital Charge Code |
64903279
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.64
|
| Rate for Payer: Aetna Government |
$2.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.64
|
| Rate for Payer: Group Health Inc Medicare |
$1.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.64
|
|
|
CANISTER VAC ATS W/GEL 500M A
|
Facility
OP
|
$882.80
|
|
| Hospital Charge Code |
64903286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$308.98 |
| Max. Negotiated Rate |
$706.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$485.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$441.40
|
| Rate for Payer: Aetna Government |
$441.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$706.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$600.30
|
| Rate for Payer: Group Health Inc Commercial |
$441.40
|
| Rate for Payer: Group Health Inc Medicare |
$308.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$441.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$441.40
|
|
|
CANISTER VAC ATS W/GEL 500M B
|
Facility
OP
|
$509.18
|
|
| Hospital Charge Code |
64903288
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$178.21 |
| Max. Negotiated Rate |
$407.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$280.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$254.59
|
| Rate for Payer: Aetna Government |
$254.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$407.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$346.24
|
| Rate for Payer: Group Health Inc Commercial |
$254.59
|
| Rate for Payer: Group Health Inc Medicare |
$178.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.59
|
|
|
CANISTER VAC ATS W/GEL500ML
|
Facility
OP
|
$96.57
|
|
| Hospital Charge Code |
64901126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$77.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.28
|
| Rate for Payer: Aetna Government |
$48.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.67
|
| Rate for Payer: Group Health Inc Commercial |
$48.28
|
| Rate for Payer: Group Health Inc Medicare |
$33.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.28
|
|
|
CANISTER VAC ATS W/O GEL 500 A
|
Facility
OP
|
$424.50
|
|
| Hospital Charge Code |
64903304
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.58 |
| Max. Negotiated Rate |
$339.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.25
|
| Rate for Payer: Aetna Government |
$212.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$339.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$288.66
|
| Rate for Payer: Group Health Inc Commercial |
$212.25
|
| Rate for Payer: Group Health Inc Medicare |
$148.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.25
|
|
|
CANISTER VAC FREEDOM W/GEL
|
Facility
OP
|
$845.40
|
|
| Hospital Charge Code |
64903340
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$295.89 |
| Max. Negotiated Rate |
$676.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$464.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$422.70
|
| Rate for Payer: Aetna Government |
$422.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$676.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$574.87
|
| Rate for Payer: Group Health Inc Commercial |
$422.70
|
| Rate for Payer: Group Health Inc Medicare |
$295.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.70
|
|
|
CANISTER VAC FREEDOM W/GEL 300
|
Facility
OP
|
$477.95
|
|
| Hospital Charge Code |
64903306
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.28 |
| Max. Negotiated Rate |
$382.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$262.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$238.98
|
| Rate for Payer: Aetna Government |
$238.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$382.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$325.01
|
| Rate for Payer: Group Health Inc Commercial |
$238.98
|
| Rate for Payer: Group Health Inc Medicare |
$167.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.98
|
|
|
CANISTER VAC ULTA 1000ML
|
Facility
OP
|
$148.41
|
|
| Hospital Charge Code |
64901535
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$118.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.20
|
| Rate for Payer: Aetna Government |
$74.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$118.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.92
|
| Rate for Payer: Group Health Inc Commercial |
$74.20
|
| Rate for Payer: Group Health Inc Medicare |
$51.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.20
|
|
|
CANISTER VAC ULTA 500ML
|
Facility
OP
|
$91.74
|
|
| Hospital Charge Code |
64901537
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$73.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.87
|
| Rate for Payer: Aetna Government |
$45.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.38
|
| Rate for Payer: Group Health Inc Commercial |
$45.87
|
| Rate for Payer: Group Health Inc Medicare |
$32.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.87
|
|
|
CANNABINOID CONFIRMATION, UR
|
Facility
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 80349
|
| Hospital Charge Code |
40609018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.50
|
| 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 |
$56.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.60
|
| Rate for Payer: Group Health Inc Commercial |
$35.00
|
| Rate for Payer: Group Health Inc Medicare |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
|
|
CANN COUNTERSINK 4.0MM SCRW W/AO
|
Facility
IP
|
$392.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.00
|
|
|
CANN COUNTERSINK 4.0MM SCRW W/AO
|
Facility
OP
|
$392.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$411.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$215.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$225.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$411.60
|
| Rate for Payer: Group Health Inc Commercial |
$196.00
|
| Rate for Payer: Group Health Inc Medicare |
$137.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$254.80
|
|
