|
CATH ULTV .018 6 X 100 X 75CM
|
Facility
OP
|
$625.00
|
|
| Hospital Charge Code |
64906192
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.50
|
| Rate for Payer: Aetna Government |
$312.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$425.00
|
| Rate for Payer: Group Health Inc Commercial |
$312.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.50
|
|
|
CATH ULTV .018 6 X 220 X 7130CM
|
Facility
OP
|
$625.00
|
|
| Hospital Charge Code |
64906190
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.50
|
| Rate for Payer: Aetna Government |
$312.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$425.00
|
| Rate for Payer: Group Health Inc Commercial |
$312.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.50
|
|
|
CATH ULTV .018 6 X 220 X 75CM
|
Facility
OP
|
$625.00
|
|
| Hospital Charge Code |
64906193
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.50
|
| Rate for Payer: Aetna Government |
$312.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$425.00
|
| Rate for Payer: Group Health Inc Commercial |
$312.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.50
|
|
|
CATH ULTV .018 6 X 4 X 130CM
|
Facility
OP
|
$625.00
|
|
| Hospital Charge Code |
64906188
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.50
|
| Rate for Payer: Aetna Government |
$312.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$425.00
|
| Rate for Payer: Group Health Inc Commercial |
$312.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.50
|
|
|
CATH ULTV .018 6 X 4 X 75CM
|
Facility
OP
|
$625.00
|
|
| Hospital Charge Code |
64906191
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.50
|
| Rate for Payer: Aetna Government |
$312.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$425.00
|
| Rate for Payer: Group Health Inc Commercial |
$312.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.50
|
|
|
CATH ULTV .035 7 X 100 X 75CM
|
Facility
OP
|
$1,007.50
|
|
| Hospital Charge Code |
64906195
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$352.62 |
| Max. Negotiated Rate |
$806.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$554.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$503.75
|
| Rate for Payer: Aetna Government |
$503.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$806.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$685.10
|
| Rate for Payer: Group Health Inc Commercial |
$503.75
|
| Rate for Payer: Group Health Inc Medicare |
$352.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$503.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$503.75
|
|
|
CATH ULTV .035 7 X 200 X 75CM
|
Facility
OP
|
$1,007.50
|
|
| Hospital Charge Code |
64906196
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$352.62 |
| Max. Negotiated Rate |
$806.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$554.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$503.75
|
| Rate for Payer: Aetna Government |
$503.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$806.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$685.10
|
| Rate for Payer: Group Health Inc Commercial |
$503.75
|
| Rate for Payer: Group Health Inc Medicare |
$352.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$503.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$503.75
|
|
|
CATH ULTV .035 7 X 4 X 75CM
|
Facility
OP
|
$625.00
|
|
| Hospital Charge Code |
64906194
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.50
|
| Rate for Payer: Aetna Government |
$312.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$425.00
|
| Rate for Payer: Group Health Inc Commercial |
$312.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.50
|
|
|
CATH URETERAL 5FR OPEN END
|
Facility
OP
|
$472.00
|
|
| Hospital Charge Code |
40209764
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$377.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$259.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$236.00
|
| Rate for Payer: Aetna Government |
$236.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$377.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$320.96
|
| Rate for Payer: Group Health Inc Commercial |
$236.00
|
| Rate for Payer: Group Health Inc Medicare |
$165.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.00
|
|
|
CATH URETERAL DUAL LUMEN 10FR
|
Facility
OP
|
$174.25
|
|
| Hospital Charge Code |
64903081
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$60.99 |
| Max. Negotiated Rate |
$139.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.12
|
| Rate for Payer: Aetna Government |
$87.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$139.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$118.49
|
| Rate for Payer: Group Health Inc Commercial |
$87.12
|
| Rate for Payer: Group Health Inc Medicare |
$60.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.12
|
|
|
CATHURETERAL DUAL LUMEN 10FRX50CM
|
Facility
OP
|
$170.00
|
|
| Hospital Charge Code |
40209788
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.00
|
| Rate for Payer: Aetna Government |
$85.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.60
|
| Rate for Payer: Group Health Inc Commercial |
$85.00
|
| Rate for Payer: Group Health Inc Medicare |
$59.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.00
|
|
|
CATH URODYNAMIC RECTAL 14F STR
|
Facility
OP
|
$479.08
|
|
| Hospital Charge Code |
64904031
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$167.68 |
| Max. Negotiated Rate |
$383.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$263.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$239.54
|
| Rate for Payer: Aetna Government |
$239.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$383.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$325.77
|
| Rate for Payer: Group Health Inc Commercial |
$239.54
|
| Rate for Payer: Group Health Inc Medicare |
$167.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.54
|
|
|
CATH URODYNAMIC TWIN LUM 8FR
|
Facility
OP
|
$21.22
|
|
| Hospital Charge Code |
64904452
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.61
|
| Rate for Payer: Aetna Government |
$10.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.43
|
| Rate for Payer: Group Health Inc Commercial |
$10.61
|
| Rate for Payer: Group Health Inc Medicare |
$7.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.61
|
|
|
CATH URTH RRUB 12F 2EYE FUNNEL
|
Facility
OP
|
$0.85
|
|
| Hospital Charge Code |
64904713
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.43
|
| Rate for Payer: Aetna Government |
$0.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.43
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.43
|
|
|
CATH VENTRIC 1MM ID 120CML
|
Facility
OP
|
$462.50
|
|
| Hospital Charge Code |
64904320
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$161.88 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.25
|
| Rate for Payer: Aetna Government |
$231.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$370.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$314.50
|
| Rate for Payer: Group Health Inc Commercial |
$231.25
|
| Rate for Payer: Group Health Inc Medicare |
$161.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.25
|
|
|
CATH VENTRICULAR HAKIM
|
Facility
OP
|
$472.50
|
|
| Hospital Charge Code |
64905923
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$165.38 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$259.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$236.25
|
| Rate for Payer: Aetna Government |
$236.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$378.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$321.30
|
| Rate for Payer: Group Health Inc Commercial |
$236.25
|
| Rate for Payer: Group Health Inc Medicare |
$165.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.25
|
|
|
CATH VENTRICULAR STRIGHT, REGULAR
|
Facility
OP
|
$415.00
|
|
| Hospital Charge Code |
64904138
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$145.25 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$228.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$207.50
|
| Rate for Payer: Aetna Government |
$207.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$332.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$282.20
|
| Rate for Payer: Group Health Inc Commercial |
$207.50
|
| Rate for Payer: Group Health Inc Medicare |
$145.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.50
|
|
|
CATRACT EXTRACTN, IOL IMPLANT
|
Facility
OP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66983
|
| Hospital Charge Code |
40072470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,694.88
|
| 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 |
$2,694.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,290.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,398.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,694.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,398.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,694.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,694.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,694.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,694.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,155.90
|
| Rate for Payer: Wellcare Medicare |
$2,560.14
|
|
|
CAT SCAN (HEAD)
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 70450 TC
|
| Hospital Charge Code |
41102384
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$77.59 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.59
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.21
|
|
|
CAUTERIZATION OF CERVIX
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
40054240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.18 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
CAUTERIZATION W/CONTROL OF BLEED
|
Facility
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 46614
|
| Hospital Charge Code |
30106624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.89 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,364.66
|
| Rate for Payer: Aetna Government |
$1,364.66
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,364.66
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,364.66
|
| 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 |
$1,364.66
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,364.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.55
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,364.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,364.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,364.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,364.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,091.73
|
| Rate for Payer: Wellcare Medicare |
$1,296.43
|
|
|
CAUTERY HOT TIP
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
64903032
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
CBC//DIFF
|
Facility
OP
|
$19.43
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
40621542
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.77
|
| Rate for Payer: Aetna Government |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.77
|
| Rate for Payer: EmblemHealth Commercial |
$7.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.92
|
| Rate for Payer: Group Health Inc Commercial |
$7.77
|
| Rate for Payer: Group Health Inc Medicare |
$7.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.77
|
| Rate for Payer: Healthfirst QHP |
$7.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.22
|
| Rate for Payer: Wellcare Medicare |
$6.99
|
|
|
CBC/DIFF/RETICULOCYTE
|
Facility
OP
|
$19.43
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
40621549
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.77
|
| Rate for Payer: Aetna Government |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.77
|
| Rate for Payer: EmblemHealth Commercial |
$7.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.92
|
| Rate for Payer: Group Health Inc Commercial |
$7.77
|
| Rate for Payer: Group Health Inc Medicare |
$7.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.77
|
| Rate for Payer: Healthfirst QHP |
$7.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.22
|
| Rate for Payer: Wellcare Medicare |
$6.99
|
|
|
CBC W/DIFFERENTIAL
|
Facility
OP
|
$19.43
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
40621544
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.77
|
| Rate for Payer: Aetna Government |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.77
|
| Rate for Payer: EmblemHealth Commercial |
$7.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.92
|
| Rate for Payer: Group Health Inc Commercial |
$7.77
|
| Rate for Payer: Group Health Inc Medicare |
$7.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.77
|
| Rate for Payer: Healthfirst QHP |
$7.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.22
|
| Rate for Payer: Wellcare Medicare |
$6.99
|
|
