|
AIRWAY BERMAN MEDIUM 90MM
|
Facility
OP
|
$2.67
|
|
| Hospital Charge Code |
64901942
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.34
|
| Rate for Payer: Aetna Government |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.82
|
| Rate for Payer: Group Health Inc Commercial |
$1.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.34
|
|
|
AIRWAY BERMAN SMALL 80MM
|
Facility
OP
|
$1.13
|
|
| Hospital Charge Code |
64901945
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.57
|
| Rate for Payer: Aetna Government |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.77
|
| Rate for Payer: Group Health Inc Commercial |
$0.57
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.57
|
|
|
AIRWAY GUEDEL 50MM COLOR CODED
|
Facility
OP
|
$2.69
|
|
| Hospital Charge Code |
64904498
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.34
|
| Rate for Payer: Aetna Government |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.83
|
| Rate for Payer: Group Health Inc Commercial |
$1.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.34
|
|
|
AIRWAY GUEDEL 70MM COLOR CODED
|
Facility
OP
|
$1.69
|
|
| Hospital Charge Code |
64904312
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.85
|
| Rate for Payer: Aetna Government |
$0.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.85
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.85
|
|
|
AIRWAY INHALATION EACH ADD'L TX
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640 76
|
| Hospital Charge Code |
30103319
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$278.59
|
| Rate for Payer: Aetna Government |
$278.59
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Group Health Inc Commercial |
$278.59
|
| Rate for Payer: Group Health Inc Medicare |
$195.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.59
|
|
|
AIRWAY INHALATION TREATMENT
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
30103324
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
AIRWAY NASAL 16FR
|
Facility
OP
|
$12.95
|
|
| Hospital Charge Code |
64905006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.81
|
| Rate for Payer: Group Health Inc Commercial |
$6.48
|
| Rate for Payer: Group Health Inc Medicare |
$4.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.48
|
|
|
AIRWAY NASAL 18FR
|
Facility
OP
|
$12.95
|
|
| Hospital Charge Code |
64905008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.81
|
| Rate for Payer: Group Health Inc Commercial |
$6.48
|
| Rate for Payer: Group Health Inc Medicare |
$4.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.48
|
|
|
AIRWAY NASAL 20FR
|
Facility
OP
|
$12.95
|
|
| Hospital Charge Code |
64905010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.81
|
| Rate for Payer: Group Health Inc Commercial |
$6.48
|
| Rate for Payer: Group Health Inc Medicare |
$4.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.48
|
|
|
AIRWAY NASAL 22FR
|
Facility
OP
|
$12.95
|
|
| Hospital Charge Code |
64905012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.81
|
| Rate for Payer: Group Health Inc Commercial |
$6.48
|
| Rate for Payer: Group Health Inc Medicare |
$4.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.48
|
|
|
AIRWAY NASAL 24FR
|
Facility
OP
|
$12.95
|
|
| Hospital Charge Code |
64905014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$10.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.81
|
| Rate for Payer: Group Health Inc Commercial |
$6.48
|
| Rate for Payer: Group Health Inc Medicare |
$4.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.48
|
|
|
AIRWAY NASAL FLANGE
|
Facility
OP
|
$19.01
|
|
| Hospital Charge Code |
64906828
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.50
|
| Rate for Payer: Aetna Government |
$9.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.93
|
| Rate for Payer: Group Health Inc Commercial |
$9.50
|
| Rate for Payer: Group Health Inc Medicare |
$6.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.50
|
|
|
AIRWAY NASAL PEDIATRIC 18 FR
|
Facility
OP
|
$42.00
|
|
| Hospital Charge Code |
40201021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.00
|
| Rate for Payer: Aetna Government |
$21.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
|
|
AIRWAY NASLA PEDIATRIC 16 FR
|
Facility
OP
|
$42.00
|
|
| Hospital Charge Code |
40201020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.00
|
| Rate for Payer: Aetna Government |
$21.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
|
|
AIRWAY,NASOPHARYNGEAL,6MM ID,8MM
|
Facility
OP
|
$7.67
|
|
| Hospital Charge Code |
64901956
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.22
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$2.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.84
|
|
|
AIRWAY,NASOPHARYNGEAL,7MM ID,9.5
|
Facility
OP
|
$8.14
|
|
| Hospital Charge Code |
64901958
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.07
|
| Rate for Payer: Aetna Government |
$4.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.54
|
| Rate for Payer: Group Health Inc Commercial |
$4.07
|
| Rate for Payer: Group Health Inc Medicare |
$2.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.07
|
|
|
AIRWAY,NASOPHARYNGEAL,8MMID,10,5
|
Facility
OP
|
$8.14
|
|
| Hospital Charge Code |
64901893
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.07
|
| Rate for Payer: Aetna Government |
$4.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.54
|
| Rate for Payer: Group Health Inc Commercial |
$4.07
|
| Rate for Payer: Group Health Inc Medicare |
$2.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.07
|
|
|
AIRWAY,NASOPHARYNGEAL,9MM ID,12
|
Facility
OP
|
$8.14
|
|
| Hospital Charge Code |
64901964
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$6.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.07
|
| Rate for Payer: Aetna Government |
$4.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.54
|
| Rate for Payer: Group Health Inc Commercial |
$4.07
|
| Rate for Payer: Group Health Inc Medicare |
$2.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.07
|
|
|
AIRWAY ORAL 40MM
|
Facility
OP
|
$0.46
|
|
| Hospital Charge Code |
64902425
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.23
|
| Rate for Payer: Aetna Government |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
|
|
AIRWAY ORAL 60MM
|
Facility
OP
|
$0.76
|
|
| Hospital Charge Code |
64902427
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
|
|
AIRWAY ORAL PEDS SIZE 000 L/F
|
Facility
OP
|
$42.50
|
|
| Hospital Charge Code |
64901725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.25
|
| Rate for Payer: Aetna Government |
$21.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.90
|
| Rate for Payer: Group Health Inc Commercial |
$21.25
|
| Rate for Payer: Group Health Inc Medicare |
$14.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.25
|
|
|
AIRWAY ORAL PEDS SIZE 00 L/F
|
Facility
OP
|
$42.50
|
|
| Hospital Charge Code |
64901724
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.25
|
| Rate for Payer: Aetna Government |
$21.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.90
|
| Rate for Payer: Group Health Inc Commercial |
$21.25
|
| Rate for Payer: Group Health Inc Medicare |
$14.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.25
|
|
|
AIRWAY ORAL PEDS SIZE 2 NON-ST
|
Facility
OP
|
$25.23
|
|
| Hospital Charge Code |
64904203
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$20.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.62
|
| Rate for Payer: Aetna Government |
$12.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.16
|
| Rate for Payer: Group Health Inc Commercial |
$12.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.62
|
|
|
AIRWAY OVASSAPIAN
|
Facility
OP
|
$14.22
|
|
| Hospital Charge Code |
64904307
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.11
|
| Rate for Payer: Aetna Government |
$7.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.67
|
| Rate for Payer: Group Health Inc Commercial |
$7.11
|
| Rate for Payer: Group Health Inc Medicare |
$4.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.11
|
|
|
AIRWAY PEDIATRIC SIZE 1
|
Facility
OP
|
$46.25
|
|
| Hospital Charge Code |
64904225
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.12
|
| Rate for Payer: Aetna Government |
$23.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.45
|
| Rate for Payer: Group Health Inc Commercial |
$23.12
|
| Rate for Payer: Group Health Inc Medicare |
$16.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.12
|
|
