|
DRAIN SKENE'S GLAND ABSESS OR CYS
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 53060
|
| Hospital Charge Code |
30105306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,355.42
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$185.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| 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 |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
DRAIN T-TUBE XEAY OPAQUE 16FR
|
Facility
OP
|
$24.64
|
|
| Hospital Charge Code |
40200418
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.32
|
| Rate for Payer: Aetna Government |
$12.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.32
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.32
|
|
|
DRAIN T-TUBE XRAY OPAQUE 12FR
|
Facility
OP
|
$74.45
|
|
| Hospital Charge Code |
40200416
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$59.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.22
|
| Rate for Payer: Aetna Government |
$37.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.63
|
| Rate for Payer: Group Health Inc Commercial |
$37.22
|
| Rate for Payer: Group Health Inc Medicare |
$26.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.22
|
|
|
DRAIN T-TUBE XRAY OPAQUE 14FR
|
Facility
OP
|
$24.64
|
|
| Hospital Charge Code |
40200417
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.32
|
| Rate for Payer: Aetna Government |
$12.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.32
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.32
|
|
|
DRAIN T-TUBE XRAY OPAQUE 8FR
|
Facility
OP
|
$24.66
|
|
| Hospital Charge Code |
40202186
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.33
|
| Rate for Payer: Aetna Government |
$12.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.77
|
| Rate for Payer: Group Health Inc Commercial |
$12.33
|
| Rate for Payer: Group Health Inc Medicare |
$8.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.33
|
|
|
DRAIN, WOUND, HEM, 19FR, 1/4
|
Facility
OP
|
$42.98
|
|
| Hospital Charge Code |
64903099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.49
|
| Rate for Payer: Aetna Government |
$21.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.23
|
| Rate for Payer: Group Health Inc Commercial |
$21.49
|
| Rate for Payer: Group Health Inc Medicare |
$15.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.49
|
|
|
DRAIN WOUND JACK PRAT 10MM FLT
|
Facility
OP
|
$99.80
|
|
| Hospital Charge Code |
40202187
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$79.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.90
|
| Rate for Payer: Aetna Government |
$49.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.86
|
| Rate for Payer: Group Health Inc Commercial |
$49.90
|
| Rate for Payer: Group Health Inc Medicare |
$34.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.90
|
|
|
DRAIN WOUND JACK PRAT 7MM FLT
|
Facility
OP
|
$82.32
|
|
| Hospital Charge Code |
64903069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$65.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.16
|
| Rate for Payer: Aetna Government |
$41.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.98
|
| Rate for Payer: Group Health Inc Commercial |
$41.16
|
| Rate for Payer: Group Health Inc Medicare |
$28.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.16
|
|
|
DRAIN WOUND JACK PRAT 7MM FLT
|
Facility
OP
|
$99.80
|
|
| Hospital Charge Code |
40202188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$79.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.90
|
| Rate for Payer: Aetna Government |
$49.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.86
|
| Rate for Payer: Group Health Inc Commercial |
$49.90
|
| Rate for Payer: Group Health Inc Medicare |
$34.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.90
|
|
|
DRAIN WOUND JACK PRAT RD 15FR
|
Facility
OP
|
$14.65
|
|
| Hospital Charge Code |
64903074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$11.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.32
|
| Rate for Payer: Aetna Government |
$7.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.96
|
| Rate for Payer: Group Health Inc Commercial |
$7.32
|
| Rate for Payer: Group Health Inc Medicare |
$5.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.32
|
|
|
DRAIN WOUND JAC PRAT 10MM FLT
|
Facility
OP
|
$82.32
|
|
| Hospital Charge Code |
64903071
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$65.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.16
|
| Rate for Payer: Aetna Government |
$41.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.98
|
| Rate for Payer: Group Health Inc Commercial |
$41.16
|
| Rate for Payer: Group Health Inc Medicare |
$28.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.16
|
|
|
DRAPE C-ARM COVER
|
Facility
OP
|
$8.46
|
|
| Hospital Charge Code |
40200420
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$6.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.23
|
| Rate for Payer: Aetna Government |
$4.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.75
|
| Rate for Payer: Group Health Inc Commercial |
$4.23
|
| Rate for Payer: Group Health Inc Medicare |
$2.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.23
|
|
|
DRAPE CHEST/BREAST
|
Facility
OP
|
$14.05
|
|
| Hospital Charge Code |
40202189
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$11.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.02
|
| Rate for Payer: Aetna Government |
$7.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.55
|
| Rate for Payer: Group Health Inc Commercial |
$7.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.02
|
|
|
DRAPE GAMMA PROBE NAVIGATOR
|
Facility
OP
|
$96.12
|
|
| Hospital Charge Code |
40205967
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$76.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.06
|
| Rate for Payer: Aetna Government |
$48.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$76.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.36
|
| Rate for Payer: Group Health Inc Commercial |
$48.06
|
| Rate for Payer: Group Health Inc Medicare |
$33.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.06
|
|
|
DRAPE HALF BODY OXIMETRY
|
Facility
OP
|
$925.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
64907176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$971.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$508.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$462.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$531.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$971.25
|
| Rate for Payer: Group Health Inc Commercial |
$462.50
|
| Rate for Payer: Group Health Inc Medicare |
$323.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$601.25
|
|
|
DRAPE HALF BODY OXIMETRY
|
Facility
IP
|
$925.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
64907176
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.50 |
| Max. Negotiated Rate |
$462.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.50
|
|
|
DRAPE INSTRUMENT MAGNETIC MEDIUM
|
Facility
OP
|
$22.70
|
|
| Hospital Charge Code |
40202190
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$18.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.35
|
| Rate for Payer: Aetna Government |
$11.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.44
|
| Rate for Payer: Group Health Inc Commercial |
$11.35
|
| Rate for Payer: Group Health Inc Medicare |
$7.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.35
|
|
|
DRAPE LASAR ARM
|
Facility
OP
|
$36.65
|
|
| Hospital Charge Code |
40200422
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$29.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.32
|
| Rate for Payer: Aetna Government |
$18.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.92
|
| Rate for Payer: Group Health Inc Commercial |
$18.32
|
| Rate for Payer: Group Health Inc Medicare |
$12.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.32
|
|
|
DRAPE MINI C-ARM 54X63
|
Facility
OP
|
$276.36
|
|
| Hospital Charge Code |
64906669
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.73 |
| Max. Negotiated Rate |
$221.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$138.18
|
| Rate for Payer: Aetna Government |
$138.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$221.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.92
|
| Rate for Payer: Group Health Inc Commercial |
$138.18
|
| Rate for Payer: Group Health Inc Medicare |
$96.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.18
|
|
|
DRAPE STERI 1010 3M
|
Facility
OP
|
$3.43
|
|
| Hospital Charge Code |
40200423
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Government |
$1.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.33
|
| Rate for Payer: Group Health Inc Commercial |
$1.72
|
| Rate for Payer: Group Health Inc Medicare |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.72
|
|
|
DRAPE STERI U 1015 3M
|
Facility
OP
|
$8.88
|
|
| Hospital Charge Code |
40200425
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.44
|
| Rate for Payer: Aetna Government |
$4.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.04
|
| Rate for Payer: Group Health Inc Commercial |
$4.44
|
| Rate for Payer: Group Health Inc Medicare |
$3.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.44
|
|
|
DRAPE TRUP LINGEMAN STERILE
|
Facility
OP
|
$68.22
|
|
| Hospital Charge Code |
40205983
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$54.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.11
|
| Rate for Payer: Aetna Government |
$34.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.39
|
| Rate for Payer: Group Health Inc Commercial |
$34.11
|
| Rate for Payer: Group Health Inc Medicare |
$23.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.11
|
|
|
DRAPE XRAY CASSETTE (24 LNG)
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
40202192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
|
|
DRAWING BLOOD FOR SPECIMEN
|
Facility
OP
|
$9.71
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30300179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$926.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.57
|
| Rate for Payer: Aetna Government |
$8.57
|
| Rate for Payer: Amida Care Medicaid |
$9.26
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.57
|
| Rate for Payer: EmblemHealth Commercial |
$8.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Group Health Inc Commercial |
$8.57
|
| Rate for Payer: Group Health Inc Medicare |
$8.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Healthfirst Essential Plan |
$20.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.28
|
| Rate for Payer: Healthfirst QHP |
$9.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.26
|
| Rate for Payer: SOMOS Essential |
$20.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.86
|
| Rate for Payer: Wellcare Medicare |
$7.71
|
|
|
DRAWING BLOOD FROM SPECIMEN
|
Facility
OP
|
$9.71
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
30103226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$926.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.57
|
| Rate for Payer: Aetna Government |
$8.57
|
| Rate for Payer: Amida Care Medicaid |
$9.26
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.57
|
| Rate for Payer: EmblemHealth Commercial |
$8.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Group Health Inc Commercial |
$8.57
|
| Rate for Payer: Group Health Inc Medicare |
$8.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Healthfirst Essential Plan |
$20.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.28
|
| Rate for Payer: Healthfirst QHP |
$9.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.26
|
| Rate for Payer: SOMOS Essential |
$20.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.86
|
| Rate for Payer: Wellcare Medicare |
$7.71
|
|
