|
Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 36598
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| 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 |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$247.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| Rate for Payer: Group Health Inc Commercial |
$247.87
|
| Rate for Payer: Group Health Inc Medicare |
$247.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
CONTRAST X-RAY EXAM OF COLON LVL1
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74283 TC
|
| Hospital Charge Code |
30101157
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.54 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.54
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.05
|
|
|
CONTROL, CA/CB/CC
|
Facility
OP
|
$249.85
|
|
| Hospital Charge Code |
64903564
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.45 |
| Max. Negotiated Rate |
$199.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$124.92
|
| Rate for Payer: Aetna Government |
$124.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$199.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$169.90
|
| Rate for Payer: Group Health Inc Commercial |
$124.92
|
| Rate for Payer: Group Health Inc Medicare |
$87.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.92
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
30103033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| 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
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
30300160
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| 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
|
|
|
CONTROL OF NOSEBLEED
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
30103034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.74 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| 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
|
|
|
CONTROL OF NOSEBLEED
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
40109233
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$86.74 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| 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
|
|
|
CONTROL OROPHARYNGEAL HEM, SIMPLE
|
Facility
OP
|
$1,337.85
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
30105560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$636.27
|
| Rate for Payer: Aetna Government |
$636.27
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$636.27
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$636.27
|
| 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 |
$636.27
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$636.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.28
|
| 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 |
$668.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$636.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$636.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$636.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$636.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$636.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$509.02
|
| Rate for Payer: Wellcare Medicare |
$604.46
|
|
|
CONTROL OROPHARYNGEAL HEM, SIMPLE
|
Facility
OP
|
$1,337.85
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
30305560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$636.27
|
| Rate for Payer: Aetna Government |
$636.27
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$636.27
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$636.27
|
| 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 |
$636.27
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$636.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.28
|
| 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 |
$668.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$636.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$636.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$636.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$636.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$636.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$509.02
|
| Rate for Payer: Wellcare Medicare |
$604.46
|
|
|
CONTROL QUIK CLOT
|
Facility
OP
|
$409.10
|
|
| Hospital Charge Code |
64907149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$143.18 |
| Max. Negotiated Rate |
$327.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$204.55
|
| Rate for Payer: Aetna Government |
$204.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$327.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$278.19
|
| Rate for Payer: Group Health Inc Commercial |
$204.55
|
| Rate for Payer: Group Health Inc Medicare |
$143.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.55
|
|
|
CONTROL SOLUTN GLUCOSE INFORM II
|
Facility
OP
|
$8.75
|
|
| Hospital Charge Code |
64901634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.38
|
| Rate for Payer: Aetna Government |
$4.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.95
|
| Rate for Payer: Group Health Inc Commercial |
$4.38
|
| Rate for Payer: Group Health Inc Medicare |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.38
|
|
|
CONTROL SYRINGE
|
Facility
OP
|
$81.25
|
|
| Hospital Charge Code |
64905524
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.62
|
| Rate for Payer: Aetna Government |
$40.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.25
|
| Rate for Payer: Group Health Inc Commercial |
$40.62
|
| Rate for Payer: Group Health Inc Medicare |
$28.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.62
|
|
|
CONTROL THROAT BLEEDING
|
Facility
OP
|
$1,337.85
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
40019404
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.86 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$636.27
|
| Rate for Payer: Aetna Government |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$636.27
|
| 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 |
$636.27
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$636.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.28
|
| Rate for Payer: Group Health Inc Commercial |
$636.27
|
| Rate for Payer: Group Health Inc Medicare |
$636.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$636.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$196.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$540.83
|
| Rate for Payer: Healthfirst QHP |
$636.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$636.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$636.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$509.02
|
| Rate for Payer: Wellcare Medicare |
$604.46
|
|
|
CONT VIVACIT-E NEUT LNR II 36X52
|
Facility
IP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.00 |
| Max. Negotiated Rate |
$2,744.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
|
|
CONT VIVACIT-E NEUT LNR II 36X52
|
Facility
IP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.00 |
| Max. Negotiated Rate |
$2,744.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
|
|
CONT VIVACIT-E NEUT LNR II 36X52
|
Facility
OP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,762.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,018.40
|
| 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 |
$2,744.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,155.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,762.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,744.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,920.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,567.20
|
|
|
CONT VIVACIT-E NEUT LNR II 36X52
|
Facility
OP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,762.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,018.40
|
| 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 |
$2,744.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,155.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,762.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,744.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,920.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,567.20
|
|
|
CONT VIVACIT-E NEUT LNR JJ 36X54
|
Facility
IP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.00 |
| Max. Negotiated Rate |
$2,744.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
|
|
CONT VIVACIT-E NEUT LNR JJ 36X54
|
Facility
OP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007526
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,762.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,018.40
|
| 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 |
$2,744.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,155.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,762.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,744.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,920.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,567.20
|
|
|
CONT VIVACIT-E NEUT LNR JJ 36X54
|
Facility
IP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.00 |
| Max. Negotiated Rate |
$2,744.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
|
|
CONT VIVACIT-E NEUT LNR JJ 36X54
|
Facility
OP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,762.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,018.40
|
| 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 |
$2,744.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,155.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,762.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,744.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,920.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,567.20
|
|
|
CONVALESCENT PLASMA-COVID-19
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
40708601
|
|
Hospital Revenue Code
|
383
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$97.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$97.05
|
| Rate for Payer: Aetna Government |
$97.05
|
| Rate for Payer: Brighton Health Commercial |
$97.05
|
| Rate for Payer: Cash Price |
$97.05
|
| Rate for Payer: Cash Price |
$97.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$97.05
|
| Rate for Payer: EmblemHealth Commercial |
$97.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.37
|
| Rate for Payer: Group Health Inc Commercial |
$97.05
|
| Rate for Payer: Group Health Inc Medicare |
$97.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.49
|
| Rate for Payer: Healthfirst QHP |
$97.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$77.64
|
| Rate for Payer: Wellcare Medicare |
$87.34
|
|
|
CONVATEC AQUACEL S/D 3.5X10
|
Facility
OP
|
$72.10
|
|
| Hospital Charge Code |
40205375
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.24 |
| Max. Negotiated Rate |
$57.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.05
|
| Rate for Payer: Aetna Government |
$36.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.03
|
| Rate for Payer: Group Health Inc Commercial |
$36.05
|
| Rate for Payer: Group Health Inc Medicare |
$25.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.05
|
|
|
CONVATEC G/T LOOP OSTOMY SYSTEM
|
Facility
OP
|
$64.14
|
|
| Hospital Charge Code |
40205377
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$51.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.07
|
| Rate for Payer: Aetna Government |
$32.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.62
|
| Rate for Payer: Group Health Inc Commercial |
$32.07
|
| Rate for Payer: Group Health Inc Medicare |
$22.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.07
|
|
|
CONVATEV AQUACEL S/D 3.5X14
|
Facility
OP
|
$80.34
|
|
| Hospital Charge Code |
40205376
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$64.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.17
|
| Rate for Payer: Aetna Government |
$40.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.63
|
| Rate for Payer: Group Health Inc Commercial |
$40.17
|
| Rate for Payer: Group Health Inc Medicare |
$28.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.17
|
|
