|
ABBOTT STENT 4.00MM X 12MM
|
Facility
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523399
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
|
ABBOTT STENT 4.00MM X 15MM
|
Facility
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
|
ABBOTT STENT 4.00MM X 15MM
|
Facility
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$2,310.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
| Rate for Payer: Group Health Inc Medicare |
$770.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
|
ABBOTT STENT 4.00MM X 18MM
|
Facility
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
|
ABBOTT STENT 4.00MM X 18MM
|
Facility
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523421
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$2,310.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
| Rate for Payer: Group Health Inc Medicare |
$770.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
|
ABBOTT STENT 4.00MM X 23MM
|
Facility
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
|
ABBOTT STENT 4.00MM X 23MM
|
Facility
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$2,310.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
| Rate for Payer: Group Health Inc Medicare |
$770.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
|
ABBOTT STENT 4.00MM X 28MM
|
Facility
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$2,310.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
| Rate for Payer: Group Health Inc Medicare |
$770.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
|
ABBOTT STENT 4.00MM X 28MM
|
Facility
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523423
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
|
ABBOTT STENT 4.00MM X 33MM
|
Facility
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$2,310.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
| Rate for Payer: Group Health Inc Medicare |
$770.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
|
ABBOTT STENT 4.00MM X 33MM
|
Facility
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
|
ABBOTT STENT 4.00MM X 38MM
|
Facility
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$2,310.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,210.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,100.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,265.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,310.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
| Rate for Payer: Group Health Inc Medicare |
$770.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,430.00
|
|
|
ABBOTT STENT 4.00MM X 38MM
|
Facility
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
66523425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.00
|
|
|
ABBOTT VASCULAR G/WIRE
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66521956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
ABBOTT VASCULAR G/WIRE
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66521956
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| 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 |
$100.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
ABCIXIMAB 2 MG/ML INJ
|
Facility
IP
|
$1,516.96
|
|
| Hospital Charge Code |
41645061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$758.48 |
| Max. Negotiated Rate |
$758.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$758.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$758.48
|
|
|
ABCIXIMAB 2 MG/ML INJ
|
Facility
IP
|
$1,516.96
|
|
|
Service Code
|
HCPCS J0130
|
| Hospital Charge Code |
41655061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$758.48 |
| Max. Negotiated Rate |
$758.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$758.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$758.48
|
|
|
ABCIXIMAB 2 MG/ML INJ
|
Facility
OP
|
$1,516.96
|
|
| Hospital Charge Code |
41645061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$530.94 |
| Max. Negotiated Rate |
$986.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$834.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$758.48
|
| Rate for Payer: Aetna Government |
$758.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$758.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$872.25
|
| Rate for Payer: Group Health Inc Commercial |
$758.48
|
| Rate for Payer: Group Health Inc Medicare |
$530.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$758.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$758.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$986.02
|
|
|
ABCIXIMAB 2 MG/ML INJ
|
Facility
OP
|
$1,516.96
|
|
|
Service Code
|
HCPCS J0130
|
| Hospital Charge Code |
41655061
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$530.94 |
| Max. Negotiated Rate |
$1,116.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$834.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,116.30
|
| Rate for Payer: Aetna Government |
$1,116.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$758.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$872.25
|
| Rate for Payer: Group Health Inc Commercial |
$758.48
|
| Rate for Payer: Group Health Inc Medicare |
$530.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$758.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$758.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$986.02
|
|
|
ABDM PERITONEAL LAVAGE
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
40019635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ABDOMINAL BINDER
|
Facility
OP
|
$35.79
|
|
| Hospital Charge Code |
40207596
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$28.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.34
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$12.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
|
|
ABDOMINAL HYSTERECTOMY
|
Facility
OP
|
$3,068.24
|
|
|
Service Code
|
HCPCS 58150
|
| Hospital Charge Code |
40052180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,073.88 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,687.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,267.60
|
| Rate for Payer: Aetna Government |
$1,267.60
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,135.39
|
| Rate for Payer: Group Health Inc Commercial |
$1,534.12
|
| Rate for Payer: Group Health Inc Medicare |
$1,073.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,534.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,534.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,261.54
|
|
|
Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 49083
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,048.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 49083
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$112.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ABDOMINAL PARACENTESIS W/O GUIDE
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
30105548
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,048.28
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| 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 |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
