|
BLOOD TRANSFUSION SERVICE
|
Facility
|
OP
|
$1,132.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
40003274
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$351.41 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$502.01
|
| Rate for Payer: Aetna Government |
$502.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$351.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$351.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$351.41
|
| Rate for Payer: Brighton Health Commercial |
$849.00
|
| Rate for Payer: Cash Price |
$502.01
|
| Rate for Payer: Cash Price |
$502.01
|
| Rate for Payer: Cash Price |
$502.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$502.01
|
| 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 |
$502.01
|
| Rate for Payer: EmblemHealth Commercial |
$502.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$426.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$446.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$502.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$446.79
|
| Rate for Payer: Group Health Inc Commercial |
$502.01
|
| Rate for Payer: Group Health Inc Medicare |
$502.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$502.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$426.71
|
| Rate for Payer: Healthfirst QHP |
$502.01
|
| Rate for Payer: Humana Medicare |
$512.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$502.01
|
| Rate for Payer: United Healthcare Commercial |
$566.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$502.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$502.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$401.61
|
| Rate for Payer: Wellcare Medicare |
$476.91
|
|
|
BLOOD TRANSFUSION SERVICE
|
Facility
|
IP
|
$1,132.00
|
|
|
Service Code
|
HCPCS 36430
|
| Hospital Charge Code |
40003274
|
|
Hospital Revenue Code
|
391
|
| Rate for Payer: Cash Price |
$502.01
|
|
|
BLOODTUBING ST W/TRANS PROTECT
|
Facility
|
OP
|
$16.31
|
|
| Hospital Charge Code |
42905330
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.16
|
| Rate for Payer: Aetna Government |
$8.16
|
| Rate for Payer: Brighton Health Commercial |
$12.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.09
|
| Rate for Payer: Group Health Inc Commercial |
$8.16
|
| Rate for Payer: Group Health Inc Medicare |
$5.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.16
|
|
|
BLOOD TYPE ATIGEN DONOR EA
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86902
|
| Hospital Charge Code |
40701118
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
BLOOD TYPE ATIGEN DONOR EA
|
Facility
|
IP
|
$858.38
|
|
|
Service Code
|
HCPCS 86902
|
| Hospital Charge Code |
40701118
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$415.67
|
|
|
BLOOD Y TRANSFUSION SET
|
Facility
|
OP
|
$9.57
|
|
| Hospital Charge Code |
40509798
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Brighton Health Commercial |
$7.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
BLOOM SYNDROME, DNA ANALYSIS
|
Facility
|
OP
|
$98.28
|
|
|
Service Code
|
HCPCS 81209
|
| Hospital Charge Code |
40603057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.31
|
| Rate for Payer: Aetna Government |
$39.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.52
|
| Rate for Payer: Brighton Health Commercial |
$73.71
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$39.31
|
| Rate for Payer: EmblemHealth Commercial |
$39.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.99
|
| Rate for Payer: Group Health Inc Commercial |
$39.31
|
| Rate for Payer: Group Health Inc Medicare |
$39.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.31
|
| Rate for Payer: Healthfirst QHP |
$39.31
|
| Rate for Payer: Humana Medicare |
$40.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare Commercial |
$35.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.45
|
| Rate for Payer: Wellcare Medicare |
$35.38
|
|
|
BLOOM SYNDROME, DNA ANALYSIS
|
Facility
|
IP
|
$98.28
|
|
|
Service Code
|
HCPCS 81209
|
| Hospital Charge Code |
40603057
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$39.31
|
|
|
BLTX BIMALLEOLAR ANKLE FX W/O
|
Facility
|
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
30305377
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$190.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$190.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$190.90
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| 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 |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.80
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: Humana Medicare |
$278.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
BLTX BIMALLEOLAR ANKLE FX W/O
|
Facility
|
IP
|
$653.13
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
30305377
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$272.71
|
|
|
BLUE DIALYZERS
|
Facility
|
OP
|
$52.45
|
|
| Hospital Charge Code |
42905311
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$41.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.22
|
| Rate for Payer: Aetna Government |
$26.22
|
| Rate for Payer: Brighton Health Commercial |
$39.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.67
|
| Rate for Payer: Group Health Inc Commercial |
$26.22
|
| Rate for Payer: Group Health Inc Medicare |
$18.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.22
|
|
|
BLUE RELOAD 45MM
|
Facility
|
OP
|
$330.31
|
|
| Hospital Charge Code |
64905157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$264.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.16
|
| Rate for Payer: Aetna Government |
$165.16
|
| Rate for Payer: Brighton Health Commercial |
$247.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.61
|
| Rate for Payer: Group Health Inc Commercial |
$165.16
|
| Rate for Payer: Group Health Inc Medicare |
$115.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.16
|
|
|
BMI DOC ONL FUP NOT COMPLTD
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9716
|
| Hospital Charge Code |
30307875
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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: 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
BMI NOT DOC MEDRSN PTREF
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2181
|
| Hospital Charge Code |
30300309
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| 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: Brighton Health Commercial |
$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
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
BMM TREPHINE
|
Facility
|
OP
|
$1,275.00
|
|
| Hospital Charge Code |
64903621
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$446.25 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$701.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.50
|
| Rate for Payer: Aetna Government |
$637.50
|
| Rate for Payer: Brighton Health Commercial |
$956.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,020.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$867.00
|
| Rate for Payer: Group Health Inc Commercial |
$637.50
|
| Rate for Payer: Group Health Inc Medicare |
$446.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$637.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.50
|
|
|
BMS AB MINI VISION 2.0X8-12-15
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
66528910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$2,047.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,072.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$398.18
|
| Rate for Payer: Aetna Government |
$398.18
|
| Rate for Payer: Brighton Health Commercial |
$1,170.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$975.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,121.25
|
| Rate for Payer: EmblemHealth Commercial |
$975.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,047.50
|
| Rate for Payer: Group Health Inc Commercial |
$975.00
|
| Rate for Payer: Group Health Inc Medicare |
$682.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,267.50
|
|
|
BMS AB MINI VISION 2.0X8-12-15
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
66528910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.00
|
|
|
B.M.W. GUIDE WIRE 0.014 X 190
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66524669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$90.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$75.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.25
|
| Rate for Payer: EmblemHealth Commercial |
$75.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.50
|
| Rate for Payer: Group Health Inc Commercial |
$75.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.50
|
|
|
B.M.W. GUIDE WIRE 0.014 X 190
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66524669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
|
|
B.M.W. GUIDE WIRE 0.014 X 300
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66524671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
|
|
B.M.W. GUIDE WIRE 0.014 X 300
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66524671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$90.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$75.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.25
|
| Rate for Payer: EmblemHealth Commercial |
$75.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.50
|
| Rate for Payer: Group Health Inc Commercial |
$75.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.50
|
|
|
B-NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$98.15
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
40602037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$73.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.26
|
| Rate for Payer: Aetna Government |
$39.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.48
|
| Rate for Payer: Brighton Health Commercial |
$73.61
|
| Rate for Payer: Cash Price |
$39.26
|
| Rate for Payer: Cash Price |
$39.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$45.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$39.26
|
| Rate for Payer: EmblemHealth Commercial |
$39.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.94
|
| Rate for Payer: Group Health Inc Commercial |
$39.26
|
| Rate for Payer: Group Health Inc Medicare |
$39.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.26
|
| Rate for Payer: Healthfirst QHP |
$39.26
|
| Rate for Payer: Humana Medicare |
$40.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.26
|
| Rate for Payer: United Healthcare Commercial |
$42.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.41
|
| Rate for Payer: Wellcare Medicare |
$35.33
|
|
|
B-NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$98.15
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
40602037
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$39.26
|
|
|
BODY EXTERNAL FIX ELBOW F
|
Facility
|
OP
|
$8,206.25
|
|
| Hospital Charge Code |
64904130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,872.19 |
| Max. Negotiated Rate |
$6,565.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,513.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,103.12
|
| Rate for Payer: Aetna Government |
$4,103.12
|
| Rate for Payer: Brighton Health Commercial |
$6,154.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,565.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,580.25
|
| Rate for Payer: Group Health Inc Commercial |
$4,103.12
|
| Rate for Payer: Group Health Inc Medicare |
$2,872.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,103.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,103.12
|
|
|
BODY FLUID CELL COUNT
|
Facility
|
OP
|
$11.80
|
|
|
Service Code
|
HCPCS 89050
|
| Hospital Charge Code |
40621595
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$8.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.72
|
| Rate for Payer: Aetna Government |
$4.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.30
|
| Rate for Payer: Brighton Health Commercial |
$8.85
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.72
|
| Rate for Payer: EmblemHealth Commercial |
$4.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.20
|
| Rate for Payer: Group Health Inc Commercial |
$4.72
|
| Rate for Payer: Group Health Inc Medicare |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.72
|
| Rate for Payer: Healthfirst QHP |
$4.72
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.72
|
| Rate for Payer: United Healthcare Commercial |
$5.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.78
|
| Rate for Payer: Wellcare Medicare |
$4.25
|
|
