|
CONTROL NASAL HEMORRHAGE
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
30300160
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| 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: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| 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: 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 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 Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| 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: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
30300160
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
CONTROL NASAL HEMORRHAGE
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
30103033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.40 |
| 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: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| 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 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: Humana Medicare |
$150.67
|
| 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: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 30901
|
| Hospital Charge Code |
30103033
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
40109233
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.40 |
| 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: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| 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 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 Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
40109233
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
CONTROL OF NOSEBLEED
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
30103034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.40 |
| 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: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| 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 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: Humana Medicare |
$150.67
|
| 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: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 30903
|
| Hospital Charge Code |
30103034
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
CONTROL OROPHARYNGEAL HEM, SIMPLE
|
Facility
|
IP
|
$1,337.85
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
30105560
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$636.27
|
|
|
CONTROL OROPHARYNGEAL HEM, SIMPLE
|
Facility
|
IP
|
$1,337.85
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
30305560
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$636.27
|
|
|
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: Affinity Essential Plan 1&2 |
$445.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$445.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$445.39
|
| 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 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: Humana Medicare |
$649.00
|
| 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: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare 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 |
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: Affinity Essential Plan 1&2 |
$445.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$445.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$445.39
|
| 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 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: Humana Medicare |
$649.00
|
| 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: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare 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: Brighton Health Commercial |
$306.82
|
| 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: Brighton Health Commercial |
$6.56
|
| 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: Brighton Health Commercial |
$60.94
|
| 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 |
$445.39 |
| 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: Affinity Essential Plan 1&2 |
$445.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$445.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$445.39
|
| Rate for Payer: Brighton Health Commercial |
$1,003.39
|
| 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 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 Medicare Advantage |
$540.83
|
| Rate for Payer: Healthfirst QHP |
$636.27
|
| Rate for Payer: Humana Medicare |
$649.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$636.27
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare 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 THROAT BLEEDING
|
Facility
|
IP
|
$1,337.85
|
|
|
Service Code
|
HCPCS 42960
|
| Hospital Charge Code |
40019404
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$636.27
|
|
|
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: Brighton Health Commercial |
$3,292.80
|
| 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: EmblemHealth Commercial |
$2,744.00
|
| 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
|
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: Brighton Health Commercial |
$3,292.80
|
| 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: EmblemHealth Commercial |
$2,744.00
|
| 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
|
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: Brighton Health Commercial |
$3,292.80
|
| 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: EmblemHealth Commercial |
$2,744.00
|
| 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: Brighton Health Commercial |
$3,292.80
|
| 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: EmblemHealth Commercial |
$2,744.00
|
| 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
|
|
