|
CASTING SYS 4 EZ
|
Facility
|
OP
|
$2,685.38
|
|
| Hospital Charge Code |
64903688
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$939.88 |
| Max. Negotiated Rate |
$2,148.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,476.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,342.69
|
| Rate for Payer: Aetna Government |
$1,342.69
|
| Rate for Payer: Brighton Health Commercial |
$2,014.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,148.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,826.06
|
| Rate for Payer: Group Health Inc Commercial |
$1,342.69
|
| Rate for Payer: Group Health Inc Medicare |
$939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,342.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,342.69
|
|
|
CASTING SYSTM 3 W/2REG BOOTS
|
Facility
|
OP
|
$268.54
|
|
| Hospital Charge Code |
64905486
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$214.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.27
|
| Rate for Payer: Aetna Government |
$134.27
|
| Rate for Payer: Brighton Health Commercial |
$201.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$214.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.61
|
| Rate for Payer: Group Health Inc Commercial |
$134.27
|
| Rate for Payer: Group Health Inc Medicare |
$93.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.27
|
|
|
CASTOR OIL 60 ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41643489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
CASTOR OIL 60 ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41653489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
CAST POST AND CORE IN ADDITION TO
|
Facility
|
OP
|
$312.50
|
|
|
Service Code
|
HCPCS D2952
|
| Hospital Charge Code |
42300655
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$234.38
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
CAST POST AND CORE IN ADDITION TO
|
Facility
|
IP
|
$312.50
|
|
|
Service Code
|
HCPCS D2952
|
| Hospital Charge Code |
42300655
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
CATARACT EXTRACTION
|
Facility
|
IP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66940
|
| Hospital Charge Code |
40072465
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,694.88
|
|
|
CATARACT EXTRACTION
|
Facility
|
OP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66940
|
| Hospital Charge Code |
40072465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$4,592.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,886.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,886.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,886.42
|
| Rate for Payer: Brighton Health Commercial |
$4,592.78
|
| 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: Humana Medicare |
$2,748.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CATARACT SURG W/IOL 1 STAGE
|
Facility
|
OP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66984
|
| Hospital Charge Code |
30302030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| 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: Affinity Essential Plan 1&2 |
$1,886.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,886.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,886.42
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: 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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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: Humana Medicare |
$2,748.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,694.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CATARACT SURG W/IOL 1 STAGE
|
Facility
|
IP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66984
|
| Hospital Charge Code |
40073277
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,694.88
|
|
|
CATARACT SURG W/IOL 1 STAGE
|
Facility
|
IP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66984
|
| Hospital Charge Code |
30302030
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$2,694.88
|
|
|
CATARACT SURG W/IOL 1 STAGE
|
Facility
|
OP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66984
|
| Hospital Charge Code |
40073277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,592.78 |
| 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: Affinity Essential Plan 1&2 |
$1,886.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,886.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,886.42
|
| Rate for Payer: Brighton Health Commercial |
$4,592.78
|
| 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: Humana Medicare |
$2,748.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CATECHOLAMINES, PLASMA
|
Facility
|
IP
|
$63.13
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
40609049
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$25.25
|
|
|
CATECHOLAMINES, PLASMA
|
Facility
|
OP
|
$63.13
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
40609049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$47.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.25
|
| Rate for Payer: Aetna Government |
$25.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.68
|
| Rate for Payer: Brighton Health Commercial |
$47.35
|
| Rate for Payer: Cash Price |
$25.25
|
| Rate for Payer: Cash Price |
$25.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.25
|
| Rate for Payer: EmblemHealth Commercial |
$25.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.47
|
| Rate for Payer: Group Health Inc Commercial |
$25.25
|
| Rate for Payer: Group Health Inc Medicare |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.25
|
| Rate for Payer: Healthfirst QHP |
$25.25
|
| Rate for Payer: Humana Medicare |
$25.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$31.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Wellcare Medicare |
$22.72
|
|
|
CATECHOLAMINES,UR.,FREE,24 HR
|
Facility
|
IP
|
$63.13
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
40609050
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$25.25
|
|
|
CATECHOLAMINES,UR.,FREE,24 HR
|
Facility
|
OP
|
$63.13
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
40609050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$47.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.25
|
| Rate for Payer: Aetna Government |
$25.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.68
|
| Rate for Payer: Brighton Health Commercial |
$47.35
|
| Rate for Payer: Cash Price |
$25.25
|
| Rate for Payer: Cash Price |
$25.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.25
|
| Rate for Payer: EmblemHealth Commercial |
$25.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.47
|
| Rate for Payer: Group Health Inc Commercial |
$25.25
|
| Rate for Payer: Group Health Inc Medicare |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.25
|
| Rate for Payer: Healthfirst QHP |
$25.25
|
| Rate for Payer: Humana Medicare |
$25.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.25
|
| Rate for Payer: United Healthcare Commercial |
$31.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Wellcare Medicare |
$22.72
|
|
|
CATH 014 3.0X40MM 150CM
|
Facility
|
OP
|
$600.00
|
|
| Hospital Charge Code |
64906780
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.00
|
| Rate for Payer: Aetna Government |
$300.00
|
| Rate for Payer: Brighton Health Commercial |
$450.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
|
|
CATH 14.5X19CM CUFFED DUAL LUMEN
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40209086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$459.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$501.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$418.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$480.70
|
| Rate for Payer: EmblemHealth Commercial |
$418.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$877.80
|
| Rate for Payer: Group Health Inc Commercial |
$418.00
|
| Rate for Payer: Group Health Inc Medicare |
$292.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$418.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$418.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$543.40
|
|
|
CATH 14.5X19CM CUFFED DUAL LUMEN
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40209086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$418.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$418.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$418.00
|
|
|
CATH < 400.00
|
Facility
|
OP
|
$357.37
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40203024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$375.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$214.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$178.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$205.49
|
| Rate for Payer: EmblemHealth Commercial |
$178.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.24
|
| Rate for Payer: Group Health Inc Commercial |
$178.68
|
| Rate for Payer: Group Health Inc Medicare |
$125.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.29
|
|
|
CATH < 400.00
|
Facility
|
IP
|
$357.37
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40203024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.68 |
| Max. Negotiated Rate |
$178.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.68
|
|
|
CATH > 400.00
|
Facility
|
IP
|
$1,096.67
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40203023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.34 |
| Max. Negotiated Rate |
$548.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$548.34
|
|
|
CATH > 400.00
|
Facility
|
OP
|
$1,096.67
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40203023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$1,151.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$603.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$658.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$548.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$630.59
|
| Rate for Payer: EmblemHealth Commercial |
$548.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,151.50
|
| Rate for Payer: Group Health Inc Commercial |
$548.34
|
| Rate for Payer: Group Health Inc Medicare |
$383.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$548.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$712.84
|
|
|
CATH 4.0-35-65-P RIM CATH 65MM
|
Facility
|
OP
|
$37.15
|
|
| Hospital Charge Code |
64905030
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$29.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.58
|
| Rate for Payer: Aetna Government |
$18.58
|
| Rate for Payer: Brighton Health Commercial |
$27.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.26
|
| Rate for Payer: Group Health Inc Commercial |
$18.58
|
| Rate for Payer: Group Health Inc Medicare |
$13.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.58
|
|
|
CATH ANGIO .035 100CM
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
64906167
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$771.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$530.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$482.00
|
| Rate for Payer: Aetna Government |
$482.00
|
| Rate for Payer: Brighton Health Commercial |
$723.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$771.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$655.52
|
| Rate for Payer: Group Health Inc Commercial |
$482.00
|
| Rate for Payer: Group Health Inc Medicare |
$337.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$482.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$482.00
|
|
