|
DIGOXIN IMMUNE FAB (DIGIBIND) 38 MG INJ
|
Facility
IP
|
$1,208.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
41641853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$604.00 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$604.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$604.00
|
|
|
DIGOXIN IMMUNE FAB (DIGIBIND) 38 MG INJ
|
Facility
OP
|
$1,208.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
41641853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$604.00 |
| Max. Negotiated Rate |
$5,064.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$664.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,777.44
|
| Rate for Payer: Aetna Government |
$4,777.44
|
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,777.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$604.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$694.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,777.44
|
| Rate for Payer: EmblemHealth Commercial |
$4,777.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,777.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,777.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,016.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,777.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,016.31
|
| Rate for Payer: Group Health Inc Commercial |
$4,777.44
|
| Rate for Payer: Group Health Inc Medicare |
$4,777.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$604.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$604.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,593.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,060.82
|
| Rate for Payer: Healthfirst QHP |
$4,777.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,777.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,064.09
|
| Rate for Payer: SOMOS Essential |
$5,064.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$785.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,821.95
|
| Rate for Payer: Wellcare Medicare |
$4,538.57
|
|
|
DIGOXIN IMMUNE FAB (DIGIBIND) 38 MG INJ
|
Facility
IP
|
$1,208.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
41651853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$604.00 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$604.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$604.00
|
|
|
DIGOXIN IMMUNE FAB (DIGIFAB) 40 MG INJ
|
Facility
OP
|
$8,560.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
41653990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,821.95 |
| Max. Negotiated Rate |
$5,564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,708.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,777.44
|
| Rate for Payer: Aetna Government |
$4,777.44
|
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,777.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,922.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,777.44
|
| Rate for Payer: EmblemHealth Commercial |
$4,777.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,777.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,777.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,016.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,777.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,016.31
|
| Rate for Payer: Group Health Inc Commercial |
$4,777.44
|
| Rate for Payer: Group Health Inc Medicare |
$4,777.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,280.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,593.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,060.82
|
| Rate for Payer: Healthfirst QHP |
$4,777.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,777.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,064.09
|
| Rate for Payer: SOMOS Essential |
$5,064.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,564.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,821.95
|
| Rate for Payer: Wellcare Medicare |
$4,538.57
|
|
|
DIGOXIN IMMUNE FAB (DIGIFAB) 40 MG INJ
|
Facility
IP
|
$8,560.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
41653990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,280.00 |
| Max. Negotiated Rate |
$4,280.00 |
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,280.00
|
|
|
DIGOXIN IMMUNE FAB (DIGIFAB) 40 MG INJ
|
Facility
IP
|
$8,560.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
41643990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,280.00 |
| Max. Negotiated Rate |
$4,280.00 |
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,280.00
|
|
|
DIGOXIN IMMUNE FAB (DIGIFAB) 40 MG INJ
|
Facility
OP
|
$8,560.00
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
41643990
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,821.95 |
| Max. Negotiated Rate |
$5,564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,708.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,777.44
|
| Rate for Payer: Aetna Government |
$4,777.44
|
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Cash Price |
$4,777.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,777.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,922.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,777.44
|
| Rate for Payer: EmblemHealth Commercial |
$4,777.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,777.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,777.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,016.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,777.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,016.31
|
| Rate for Payer: Group Health Inc Commercial |
$4,777.44
|
| Rate for Payer: Group Health Inc Medicare |
$4,777.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,280.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,593.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,060.82
|
| Rate for Payer: Healthfirst QHP |
$4,777.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,777.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5,064.09
|
| Rate for Payer: SOMOS Essential |
$5,064.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,564.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,821.95
|
| Rate for Payer: Wellcare Medicare |
$4,538.57
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJ
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
41652950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.42
|
| Rate for Payer: Aetna Government |
$47.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.53
|
| Rate for Payer: Group Health Inc Commercial |
$27.50
|
| Rate for Payer: Group Health Inc Medicare |
$19.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.34
|
| Rate for Payer: SOMOS Essential |
$39.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.75
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJ
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
41652950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.50
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJ
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
41642950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.50
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJ
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
41642950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.42
|
| Rate for Payer: Aetna Government |
$47.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.53
|
| Rate for Payer: Group Health Inc Commercial |
$27.50
|
| Rate for Payer: Group Health Inc Medicare |
$19.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.34
|
| Rate for Payer: SOMOS Essential |
$39.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.75
|
|
|
DILANTIN QUANTITATION
|
Facility
OP
|
$33.13
|
|
|
Service Code
|
HCPCS 80185
|
| Hospital Charge Code |
40602020
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$21.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.60
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
DILATE URETHRA STRICTURE
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 53600
|
| Hospital Charge Code |
30306519
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| 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 |
$285.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| 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 |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.94
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
|
DILATION OF SALIVARY DUCT
|
Facility
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 42650
|
| Hospital Charge Code |
30303076
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| 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: Elderplan Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| 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 |
$2,043.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,763.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
DILATOR, 18CM, FH 0.3MM ST
|
Facility
OP
|
$532.50
|
|
| Hospital Charge Code |
64905457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$186.38 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$292.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$266.25
|
| Rate for Payer: Aetna Government |
$266.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$426.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$362.10
|
| Rate for Payer: Group Health Inc Commercial |
$266.25
|
| Rate for Payer: Group Health Inc Medicare |
$186.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.25
|
|
|
DILATOR BALLOON CRE 6-8MM 8CM F/G
|
Facility
OP
|
$406.00
|
|
| Hospital Charge Code |
40209790
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$324.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$223.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$203.00
|
| Rate for Payer: Aetna Government |
$203.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$324.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$276.08
|
| Rate for Payer: Group Health Inc Commercial |
$203.00
|
| Rate for Payer: Group Health Inc Medicare |
$142.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.00
|
|
|
DILATOR NOTTINGHAM 6-12FR
|
Facility
OP
|
$317.75
|
|
| Hospital Charge Code |
64903080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$111.21 |
| Max. Negotiated Rate |
$254.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$158.88
|
| Rate for Payer: Aetna Government |
$158.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$254.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$158.88
|
| Rate for Payer: Group Health Inc Medicare |
$111.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.88
|
|
|
DILATOR SERIAL 20FR TELESCOPE
|
Facility
OP
|
$244.48
|
|
| Hospital Charge Code |
64902661
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.57 |
| Max. Negotiated Rate |
$195.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.24
|
| Rate for Payer: Aetna Government |
$122.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.25
|
| Rate for Payer: Group Health Inc Commercial |
$122.24
|
| Rate for Payer: Group Health Inc Medicare |
$85.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.24
|
|
|
DILATOR SERIAL TELESCOPE
|
Facility
OP
|
$237.38
|
|
| Hospital Charge Code |
64903568
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$118.69
|
| Rate for Payer: Aetna Government |
$118.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$189.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.42
|
| Rate for Payer: Group Health Inc Commercial |
$118.69
|
| Rate for Payer: Group Health Inc Medicare |
$83.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.69
|
|
|
DILATORS SOFT OS LOCATER DISPOSAB
|
Facility
OP
|
$9.78
|
|
| Hospital Charge Code |
64903242
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.89
|
| Rate for Payer: Aetna Government |
$4.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.65
|
| Rate for Payer: Group Health Inc Commercial |
$4.89
|
| Rate for Payer: Group Health Inc Medicare |
$3.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.89
|
|
|
DILATOR VASC GARRETT 3.5X210MM
|
Facility
OP
|
$57.23
|
|
| Hospital Charge Code |
64904347
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$45.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.62
|
| Rate for Payer: Aetna Government |
$28.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.92
|
| Rate for Payer: Group Health Inc Commercial |
$28.62
|
| Rate for Payer: Group Health Inc Medicare |
$20.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.62
|
|
|
DILATOR WIRE BALLN CRE 6-8MM 240C
|
Facility
OP
|
$774.38
|
|
| Hospital Charge Code |
64904298
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$271.03 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$425.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$387.19
|
| Rate for Payer: Aetna Government |
$387.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$619.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$526.58
|
| Rate for Payer: Group Health Inc Commercial |
$387.19
|
| Rate for Payer: Group Health Inc Medicare |
$271.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$387.19
|
|
|
DILATOR WIRE BALLOON CRE
|
Facility
OP
|
$598.00
|
|
| Hospital Charge Code |
40209791
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$209.30 |
| Max. Negotiated Rate |
$478.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$328.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$299.00
|
| Rate for Payer: Aetna Government |
$299.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$478.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$406.64
|
| Rate for Payer: Group Health Inc Commercial |
$299.00
|
| Rate for Payer: Group Health Inc Medicare |
$209.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$299.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$299.00
|
|
|
DILATOR WIRE BALLOON CRE 1
|
Facility
OP
|
$470.00
|
|
| Hospital Charge Code |
40200266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$235.00
|
| Rate for Payer: Aetna Government |
$235.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$376.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$319.60
|
| Rate for Payer: Group Health Inc Commercial |
$235.00
|
| Rate for Payer: Group Health Inc Medicare |
$164.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
|
|
DILATOR WIRE BALLOON CRE -15-18
|
Facility
OP
|
$581.35
|
|
| Hospital Charge Code |
64904223
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$203.47 |
| Max. Negotiated Rate |
$465.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$319.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$290.68
|
| Rate for Payer: Aetna Government |
$290.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$465.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$395.32
|
| Rate for Payer: Group Health Inc Commercial |
$290.68
|
| Rate for Payer: Group Health Inc Medicare |
$203.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.68
|
|
