|
EFAVIRENZ 50 MG CAP
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41651939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
EFAVIRENZ 600 MG TAB
|
Facility
OP
|
$37.90
|
|
| Hospital Charge Code |
41652789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$30.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.95
|
| Rate for Payer: Aetna Government |
$18.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.77
|
| Rate for Payer: Group Health Inc Commercial |
$18.95
|
| Rate for Payer: Group Health Inc Medicare |
$13.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.64
|
|
|
EFAVIRENZ 600 MG TAB
|
Facility
OP
|
$37.90
|
|
| Hospital Charge Code |
41642789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$30.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.95
|
| Rate for Payer: Aetna Government |
$18.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.77
|
| Rate for Payer: Group Health Inc Commercial |
$18.95
|
| Rate for Payer: Group Health Inc Medicare |
$13.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.64
|
|
|
EFFICA BED
|
Facility
OP
|
$382.73
|
|
| Hospital Charge Code |
40209268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$133.96 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.36
|
| Rate for Payer: Aetna Government |
$191.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.26
|
| Rate for Payer: Group Health Inc Commercial |
$191.36
|
| Rate for Payer: Group Health Inc Medicare |
$133.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.36
|
|
|
EFICARE BED
|
Facility
OP
|
$348.71
|
|
| Hospital Charge Code |
40209130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.05 |
| Max. Negotiated Rate |
$278.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$174.36
|
| Rate for Payer: Aetna Government |
$174.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$237.12
|
| Rate for Payer: Group Health Inc Commercial |
$174.36
|
| Rate for Payer: Group Health Inc Medicare |
$122.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.36
|
|
|
EGD US EXAM DUODENUM/JEJUNUM
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43259
|
| Hospital Charge Code |
41112832
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$239.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$239.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$266.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
EGD US FIND NEEDLE BX/ASPIR
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43242
|
| Hospital Charge Code |
41112831
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$280.85 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$280.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
EGD US FINE NEEDLE BX/ASPIR
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43238
|
| Hospital Charge Code |
41112830
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$247.26 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$247.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$274.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
Egg Crate Mattress
|
Facility
OP
|
$111.63
|
|
| Hospital Charge Code |
40201430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.07 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.82
|
| Rate for Payer: Aetna Government |
$55.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.91
|
| Rate for Payer: Group Health Inc Commercial |
$55.82
|
| Rate for Payer: Group Health Inc Medicare |
$39.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.82
|
|
|
EKG
|
Facility
OP
|
$145.50
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
30301306
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.04
|
| Rate for Payer: Aetna Government |
$15.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.75
|
| Rate for Payer: Group Health Inc Commercial |
$72.75
|
| Rate for Payer: Group Health Inc Medicare |
$50.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.50
|
|
|
EKG, 12 LEAD &REPORT
|
Facility
OP
|
$145.50
|
|
|
Service Code
|
HCPCS 93000
|
| Hospital Charge Code |
30301320
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.04
|
| Rate for Payer: Aetna Government |
$15.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.75
|
| Rate for Payer: Group Health Inc Commercial |
$72.75
|
| Rate for Payer: Group Health Inc Medicare |
$50.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.50
|
|
|
EKG LEADS
|
Facility
OP
|
$69.46
|
|
| Hospital Charge Code |
40201450
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$55.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.73
|
| Rate for Payer: Aetna Government |
$34.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.23
|
| Rate for Payer: Group Health Inc Commercial |
$34.73
|
| Rate for Payer: Group Health Inc Medicare |
$24.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.73
|
|
|
ELASTIC STOCKINGS
|
Facility
OP
|
$19.85
|
|
| Hospital Charge Code |
40191410
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.92
|
| Rate for Payer: Aetna Government |
$9.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.50
|
| Rate for Payer: Group Health Inc Commercial |
$9.92
|
| Rate for Payer: Group Health Inc Medicare |
$6.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
|
|
ELASTIC STOCKINGS
|
Facility
OP
|
$61.67
|
|
| Hospital Charge Code |
40201410
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$49.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.84
|
| Rate for Payer: Aetna Government |
$30.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.94
|
| Rate for Payer: Group Health Inc Commercial |
$30.84
|
| Rate for Payer: Group Health Inc Medicare |
$21.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.84
|
|
|
ELASTOSIL HANDLE W/AO COUPLING
|
Facility
OP
|
$420.00
|
|
| Hospital Charge Code |
40200644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$210.00
|
| Rate for Payer: Aetna Government |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$336.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$285.60
|
| Rate for Payer: Group Health Inc Commercial |
$210.00
|
| Rate for Payer: Group Health Inc Medicare |
$147.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.00
|
|
|
ELECTROACOUSTIC EVAL-HAE BINAURAL
|
Facility
OP
|
$212.63
|
|
|
Service Code
|
HCPCS 92595
|
| Hospital Charge Code |
42004525
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$38.99 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.99
|
| Rate for Payer: Aetna Government |
$38.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$170.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.59
|
| Rate for Payer: Group Health Inc Commercial |
$106.32
|
| Rate for Payer: Group Health Inc Medicare |
$74.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.32
|
|
|
ELECTROACOUSTIC EVAL -HAE MONAURA
|
Facility
OP
|
$141.75
|
|
|
Service Code
|
HCPCS 92594
|
| Hospital Charge Code |
42004524
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.19
|
| Rate for Payer: Aetna Government |
$18.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$113.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.39
|
| Rate for Payer: Group Health Inc Commercial |
$70.88
|
| Rate for Payer: Group Health Inc Medicare |
$49.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.88
|
|
|
ELECTROCHLEOGRAPHY
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 92584
|
| Hospital Charge Code |
42004515
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
ELECTRODE 33CM SPATULA CORBITT
|
Facility
OP
|
$118.71
|
|
| Hospital Charge Code |
64904338
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$94.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.36
|
| Rate for Payer: Aetna Government |
$59.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$94.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$80.72
|
| Rate for Payer: Group Health Inc Commercial |
$59.36
|
| Rate for Payer: Group Health Inc Medicare |
$41.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.36
|
|
|
ELECTRODE ACCESSARY ULT CLR 1
|
Facility
OP
|
$11.62
|
|
| Hospital Charge Code |
64903991
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.81
|
| Rate for Payer: Aetna Government |
$5.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.90
|
| Rate for Payer: Group Health Inc Commercial |
$5.81
|
| Rate for Payer: Group Health Inc Medicare |
$4.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.81
|
|
|
ELECTRODE ACCESSORY ULT CLEAN1
|
Facility
OP
|
$10.40
|
|
| Hospital Charge Code |
40200402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.20
|
| Rate for Payer: Aetna Government |
$5.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.07
|
| Rate for Payer: Group Health Inc Commercial |
$5.20
|
| Rate for Payer: Group Health Inc Medicare |
$3.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.20
|
|
|
ELECTRODE,ADULT,QUIKCMBO2
|
Facility
OP
|
$22.75
|
|
| Hospital Charge Code |
64903172
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.38
|
| Rate for Payer: Aetna Government |
$11.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.47
|
| Rate for Payer: Group Health Inc Commercial |
$11.38
|
| Rate for Payer: Group Health Inc Medicare |
$7.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.38
|
|
|
ELECTRODE,BALL,5MM
|
Facility
OP
|
$40.48
|
|
| Hospital Charge Code |
64903034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.24
|
| Rate for Payer: Aetna Government |
$20.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.53
|
| Rate for Payer: Group Health Inc Commercial |
$20.24
|
| Rate for Payer: Group Health Inc Medicare |
$14.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.24
|
|
|
ELECTRODE,BLADE,ULTRACLEAN,6
|
Facility
OP
|
$12.77
|
|
| Hospital Charge Code |
64903986
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$10.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.38
|
| Rate for Payer: Aetna Government |
$6.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.68
|
| Rate for Payer: Group Health Inc Commercial |
$6.38
|
| Rate for Payer: Group Health Inc Medicare |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.38
|
|
|
ELECTRODE,ECG,SNAP,TEARDROP F
|
Facility
OP
|
$0.22
|
|
| Hospital Charge Code |
64901642
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
|
