|
CBC W/O DIFFERENTIAL
|
Facility
OP
|
$16.18
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
40621547
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
CBT, 1ST HOUR
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 94644
|
| Hospital Charge Code |
40307001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$84.89 |
| Max. Negotiated Rate |
$8,489.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Amida Care Medicaid |
$84.89
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8,489.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.13
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.89
|
| Rate for Payer: Healthfirst Essential Plan |
$191.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$84.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.89
|
| Rate for Payer: SOMOS Essential |
$191.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
CBT, EACH ADDL HOUR
|
Facility
OP
|
$42.90
|
|
|
Service Code
|
HCPCS 94645
|
| Hospital Charge Code |
30103325
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$8,489.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Amida Care Medicaid |
$84.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8,489.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.13
|
| Rate for Payer: Group Health Inc Commercial |
$21.45
|
| Rate for Payer: Group Health Inc Medicare |
$15.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.89
|
| Rate for Payer: Healthfirst Essential Plan |
$191.00
|
| Rate for Payer: Healthfirst QHP |
$84.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.89
|
| Rate for Payer: SOMOS Essential |
$191.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.89
|
|
|
CC .035 TERUMO ANG (150CM)
|
Facility
OP
|
$61.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$64.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.47
|
| Rate for Payer: Group Health Inc Commercial |
$30.70
|
| Rate for Payer: Group Health Inc Medicare |
$21.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.91
|
|
|
CC .035 TERUMO ANG (150CM)
|
Facility
IP
|
$61.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.70
|
|
|
CC .035 TERUMO ANG (260CM)
|
Facility
IP
|
$98.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.10 |
| Max. Negotiated Rate |
$49.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.10
|
|
|
CC .035 TERUMO ANG (260CM)
|
Facility
OP
|
$98.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$103.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.11
|
| Rate for Payer: Group Health Inc Commercial |
$49.10
|
| Rate for Payer: Group Health Inc Medicare |
$34.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.83
|
|
|
CC.035TERUMO ANG,STIFF(180CM)
|
Facility
IP
|
$104.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.10 |
| Max. Negotiated Rate |
$52.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.10
|
|
|
CC.035TERUMO ANG,STIFF(180CM)
|
Facility
OP
|
$104.20
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528825
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.47 |
| Max. Negotiated Rate |
$109.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.41
|
| Rate for Payer: Group Health Inc Commercial |
$52.10
|
| Rate for Payer: Group Health Inc Medicare |
$36.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.73
|
|
|
CC .035 TERUMO STR (150CM)
|
Facility
IP
|
$63.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.50
|
|
|
CC .035 TERUMO STR (150CM)
|
Facility
OP
|
$63.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$66.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.15
|
| Rate for Payer: Group Health Inc Commercial |
$31.50
|
| Rate for Payer: Group Health Inc Medicare |
$22.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.95
|
|
|
CC.035TERUMO STR,STIFF(260CM)
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$114.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.45
|
| Rate for Payer: Group Health Inc Commercial |
$54.50
|
| Rate for Payer: Group Health Inc Medicare |
$38.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.85
|
|
|
CC.035TERUMO STR,STIFF(260CM)
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528824
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.50
|
|
|
CC.035ZIPWIREHYDROPHILICGUIDEWIR
|
Facility
OP
|
$109.00
|
|
| Hospital Charge Code |
66528832
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$87.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.50
|
| Rate for Payer: Aetna Government |
$54.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.12
|
| Rate for Payer: Group Health Inc Commercial |
$54.50
|
| Rate for Payer: Group Health Inc Medicare |
$38.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.50
|
|
|
CC .038 TERUMO ANG (150CM)
|
Facility
OP
|
$64.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$67.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.83
|
| Rate for Payer: Group Health Inc Commercial |
$32.30
|
| Rate for Payer: Group Health Inc Medicare |
$22.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.99
|
|
|
CC .038 TERUMO ANG (150CM)
|
Facility
IP
|
$64.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528828
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.30
|
|
|
CC .038 TERUMO STR,STIFF(150CM)
|
Facility
OP
|
$99.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$104.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.79
|
| Rate for Payer: Group Health Inc Commercial |
$49.90
|
| Rate for Payer: Group Health Inc Medicare |
$34.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.87
|
|
|
CC .038 TERUMO STR,STIFF(150CM)
|
Facility
IP
|
$99.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66528827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$49.90 |
| Max. Negotiated Rate |
$49.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.90
|
|
|
CC 1200 PSI TUBING 30 IN. MERIT
|
Facility
OP
|
$6.60
|
|
| Hospital Charge Code |
66528227
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.30
|
| Rate for Payer: Aetna Government |
$3.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.49
|
| Rate for Payer: Group Health Inc Commercial |
$3.30
|
| Rate for Payer: Group Health Inc Medicare |
$2.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.30
|
|
|
CC 4F JR 100CM
|
Facility
OP
|
$427.75
|
|
| Hospital Charge Code |
66528767
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$149.71 |
| Max. Negotiated Rate |
$342.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$235.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$213.88
|
| Rate for Payer: Aetna Government |
$213.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$342.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$290.87
|
| Rate for Payer: Group Health Inc Commercial |
$213.88
|
| Rate for Payer: Group Health Inc Medicare |
$149.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.88
|
|
|
CC 4FR CORDIS JL 100 CM
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
66528766
|
|
Hospital Revenue Code
|
279
|
| 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
|
|
|
CC 4FR PIG STR 110CM
|
Facility
OP
|
$46.00
|
|
| Hospital Charge Code |
66520304
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.00
|
| Rate for Payer: Aetna Government |
$23.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.28
|
| Rate for Payer: Group Health Inc Commercial |
$23.00
|
| Rate for Payer: Group Health Inc Medicare |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.00
|
|
|
CC 5F EBU4.0 .058
|
Facility
OP
|
$260.00
|
|
| Hospital Charge Code |
66528772
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.00
|
| Rate for Payer: Aetna Government |
$130.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.80
|
| Rate for Payer: Group Health Inc Commercial |
$130.00
|
| Rate for Payer: Group Health Inc Medicare |
$91.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.00
|
|
|
CC 5F ECR4
|
Facility
OP
|
$260.00
|
|
| Hospital Charge Code |
66528770
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.00
|
| Rate for Payer: Aetna Government |
$130.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.80
|
| Rate for Payer: Group Health Inc Commercial |
$130.00
|
| Rate for Payer: Group Health Inc Medicare |
$91.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.00
|
|
|
CC 5F JCL 3.5
|
Facility
OP
|
$260.00
|
|
| Hospital Charge Code |
66528773
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.00
|
| Rate for Payer: Aetna Government |
$130.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.80
|
| Rate for Payer: Group Health Inc Commercial |
$130.00
|
| Rate for Payer: Group Health Inc Medicare |
$91.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.00
|
|
