|
CONQUEST40 8X40/75
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
40004769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.43
|
| Rate for Payer: Aetna Government |
$17.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$399.00
|
| Rate for Payer: Group Health Inc Commercial |
$190.00
|
| Rate for Payer: Group Health Inc Medicare |
$133.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.00
|
|
|
CONQUEST 7X40/75
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
40004766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.43
|
| Rate for Payer: Aetna Government |
$17.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$399.00
|
| Rate for Payer: Group Health Inc Commercial |
$190.00
|
| Rate for Payer: Group Health Inc Medicare |
$133.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.00
|
|
|
CONQUEST 7X40/75
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
40004766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.00
|
|
|
CONSTRAINED INSERT SZ 5-6 13MM
|
Facility
OP
|
$4,700.00
|
|
| Hospital Charge Code |
64905963
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,645.00 |
| Max. Negotiated Rate |
$3,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,585.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,350.00
|
| Rate for Payer: Aetna Government |
$2,350.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,760.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,196.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,350.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,645.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,350.00
|
|
|
CONSTRAINED INSERT SZ 5-6 9MM
|
Facility
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.00 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,350.00
|
|
|
CONSTRAINED INSERT SZ 5-6 9MM
|
Facility
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904861
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,935.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,585.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,350.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,702.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,935.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,350.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,645.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,350.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,055.00
|
|
|
CONTACT TRIAL LEAD KIT
|
Facility
OP
|
$1,875.00
|
|
| Hospital Charge Code |
64905860
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,031.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$937.50
|
| Rate for Payer: Aetna Government |
$937.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,275.00
|
| Rate for Payer: Group Health Inc Commercial |
$937.50
|
| Rate for Payer: Group Health Inc Medicare |
$656.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$937.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$937.50
|
|
|
CONTAINER EVACUATED,500ML
|
Facility
OP
|
$10.54
|
|
| Hospital Charge Code |
64901114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$8.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.27
|
| Rate for Payer: Aetna Government |
$5.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.17
|
| Rate for Payer: Group Health Inc Commercial |
$5.27
|
| Rate for Payer: Group Health Inc Medicare |
$3.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.27
|
|
|
CONTAINER,GRADUATED,TRI I/O
|
Facility
OP
|
$0.52
|
|
| Hospital Charge Code |
64902031
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
|
|
CONTAINER,SPECIMEN,OR STERIL
|
Facility
OP
|
$0.95
|
|
| Hospital Charge Code |
64904801
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.65
|
| Rate for Payer: Group Health Inc Commercial |
$0.48
|
| Rate for Payer: Group Health Inc Medicare |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.48
|
|
|
CONTAINER,SPECIMEN,URIN 24HR
|
Facility
OP
|
$5.80
|
|
| Hospital Charge Code |
64902022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.90
|
| Rate for Payer: Aetna Government |
$2.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.94
|
| Rate for Payer: Group Health Inc Commercial |
$2.90
|
| Rate for Payer: Group Health Inc Medicare |
$2.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.90
|
|
|
CONTINOUS VENTILATION, FIRST DAY
|
Facility
OP
|
$1,483.00
|
|
|
Service Code
|
HCPCS 94002
|
| Hospital Charge Code |
40301500
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$96.01 |
| Max. Negotiated Rate |
$815.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$815.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$724.69
|
| Rate for Payer: Aetna Government |
$724.69
|
| Rate for Payer: Cash Price |
$724.69
|
| Rate for Payer: Cash Price |
$724.69
|
| Rate for Payer: Cash Price |
$724.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$724.69
|
| 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 |
$724.69
|
| Rate for Payer: EmblemHealth Commercial |
$724.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$615.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$644.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$724.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$644.97
|
| Rate for Payer: Group Health Inc Commercial |
$724.69
|
| Rate for Payer: Group Health Inc Medicare |
$724.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$741.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$724.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$615.99
|
| Rate for Payer: Healthfirst QHP |
$724.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$724.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$724.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$579.75
|
| Rate for Payer: Wellcare Medicare |
$688.46
|
|
|
CONTINOUS VENT, SUBSEQUENT DAYS
|
Facility
OP
|
$1,483.00
|
|
|
Service Code
|
HCPCS 94003
|
| Hospital Charge Code |
40307410
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$67.01 |
| Max. Negotiated Rate |
$815.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$815.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$724.69
|
| Rate for Payer: Aetna Government |
$724.69
|
| Rate for Payer: Cash Price |
$724.69
|
| Rate for Payer: Cash Price |
$724.69
|
| Rate for Payer: Cash Price |
$724.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$724.69
|
| 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 |
$724.69
|
| Rate for Payer: EmblemHealth Commercial |
$724.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$615.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$644.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$724.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$644.97
|
| Rate for Payer: Group Health Inc Commercial |
$724.69
|
| Rate for Payer: Group Health Inc Medicare |
$724.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$741.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$724.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$615.99
|
| Rate for Payer: Healthfirst QHP |
$724.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$724.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$724.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$579.75
|
| Rate for Payer: Wellcare Medicare |
$688.46
|
|
|
CONTINUUM CLUSTER-HOLE SHELL 52II
|
Facility
OP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,266.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,282.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,984.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,431.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,266.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,984.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,088.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,984.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,984.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,879.20
|
|
|
CONTINUUM CLUSTER-HOLE SHELL 52II
|
Facility
IP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$2,984.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,984.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,984.00
|
|
|
CONTINUUM CLUSTER-HOLE SHELL 52II
|
Facility
OP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,266.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,282.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,984.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,431.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,266.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,984.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,088.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,984.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,984.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,879.20
|
|
|
CONTINUUM CLUSTER-HOLE SHELL 52II
|
Facility
IP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$2,984.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,984.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,984.00
|
|
|
CONTINUUM CLUSTER-HOLE SHELL 54JJ
|
Facility
OP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,266.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,282.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,984.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,431.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,266.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,984.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,088.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,984.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,984.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,879.20
|
|
|
CONTINUUM CLUSTER-HOLE SHELL 54JJ
|
Facility
OP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,266.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,282.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,984.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,431.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,266.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,984.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,088.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,984.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,984.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,879.20
|
|
|
CONTINUUM CLUSTER-HOLE SHELL 54JJ
|
Facility
IP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$2,984.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,984.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,984.00
|
|
|
CONTINUUM CLUSTER-HOLE SHELL 54JJ
|
Facility
IP
|
$5,968.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,984.00 |
| Max. Negotiated Rate |
$2,984.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,984.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,984.00
|
|
|
CONTOUR CURVED CUTTER STAPLER
|
Facility
OP
|
$1,124.63
|
|
| Hospital Charge Code |
64905448
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$393.62 |
| Max. Negotiated Rate |
$899.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$618.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$562.32
|
| Rate for Payer: Aetna Government |
$562.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$899.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$764.75
|
| Rate for Payer: Group Health Inc Commercial |
$562.32
|
| Rate for Payer: Group Health Inc Medicare |
$393.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$562.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$562.32
|
|
|
CONTQCT LENWFITTING FOR FX
|
Facility
OP
|
$96.12
|
|
|
Service Code
|
HCPCS 92071
|
| Hospital Charge Code |
30305959
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.59
|
| Rate for Payer: Aetna Government |
$28.59
|
| 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: Fidelis CHP/HARP/Medicaid |
$32.89
|
| 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 |
$48.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.54
|
|
|
Contrast injection for assessment of abscess or cyst via previously placed drainage catheter or tube (separate procedure)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 49424
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.32
|
| Rate for Payer: Aetna Government |
$43.32
|
| 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: Fidelis CHP/HARP/Medicaid |
$39.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.13
|
|
|
Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including image documentation and report
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 49465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| 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 |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
