|
COVER SWITCH FOOT
|
Facility
OP
|
$700.00
|
|
| Hospital Charge Code |
64902885
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$350.00
|
| Rate for Payer: Aetna Government |
$350.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$560.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$476.00
|
| Rate for Payer: Group Health Inc Commercial |
$350.00
|
| Rate for Payer: Group Health Inc Medicare |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
|
COVER ULTRASND PROBE W/GEL ST
|
Facility
OP
|
$16.98
|
|
| Hospital Charge Code |
64903898
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.49
|
| Rate for Payer: Aetna Government |
$8.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.55
|
| Rate for Payer: Group Health Inc Commercial |
$8.49
|
| Rate for Payer: Group Health Inc Medicare |
$5.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.49
|
|
|
COVER UN3 BURRHOLE 20MM 53-34520
|
Facility
OP
|
$224.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$235.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$128.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$235.55
|
| Rate for Payer: Group Health Inc Commercial |
$112.16
|
| Rate for Payer: Group Health Inc Medicare |
$78.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.81
|
|
|
COVER UN3 BURRHOLE 20MM 53-34520
|
Facility
IP
|
$224.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.16 |
| Max. Negotiated Rate |
$112.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.16
|
|
|
COVID-19 BIVALENT 12&OLDER PFIZER
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650385
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 BIVALENT 12&OLDER PFIZER
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640385
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 BIVALENT 12&OLDER PFIZER
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640385
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID-19 BIVALENT 12&OLDER PFIZER
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650385
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID-19 BIVALENT 5-11YRS PFIZER
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID-19 BIVALENT 5-11YRS PFIZER
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID-19 BIVALENT 5-11YRS PFIZER
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640384
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 BIVALENT 5-11YRS PFIZER
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650384
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 BIVALENT 6MON-4YR PFIZER
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650397
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 BIVALENT 6MON-4YR PFIZER
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640397
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 BIVALENT 6MON-4YR PFIZER
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID-19 BIVALENT 6MON-4YR PFIZER
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID19NYR
|
Facility
OP
|
$97.50
|
|
|
Service Code
|
HCPCS U0003
|
| Hospital Charge Code |
40601995
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.00
|
| Rate for Payer: Aetna Government |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.30
|
| Rate for Payer: Group Health Inc Commercial |
$48.75
|
| Rate for Payer: Group Health Inc Medicare |
$34.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.75
|
|
|
COVID-19 PEDS VACCINE (PFIZER)
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91307
|
| Hospital Charge Code |
41640280
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 PEDS VACCINE (PFIZER)
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91307
|
| Hospital Charge Code |
41640280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID-19 PEDS VACCINE (PFIZER)
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91307
|
| Hospital Charge Code |
41650280
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 PEDS VACCINE (PFIZER)
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91307
|
| Hospital Charge Code |
41650280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID-19 PED VAC 6MON-5YR MODERNA
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91311
|
| Hospital Charge Code |
41640390
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 PED VAC 6MON-5YR MODERNA
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91311
|
| Hospital Charge Code |
41640390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID-19 PED VAC 6MON-5YR MODERNA
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 91311
|
| Hospital Charge Code |
41650390
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
COVID-19 PED VAC 6MON-5YR MODERNA
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91311
|
| Hospital Charge Code |
41650390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
