|
ENDOTRACHEL TUBE 5.0
|
Facility
OP
|
$12.10
|
|
| Hospital Charge Code |
40201521
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$9.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.05
|
| Rate for Payer: Aetna Government |
$6.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.23
|
| Rate for Payer: Group Health Inc Commercial |
$6.05
|
| Rate for Payer: Group Health Inc Medicare |
$4.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.05
|
|
|
ENDOTRACHEL TUBE 5.5
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40201522
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
ENDOTRACHEL TUBE 6.0
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40201523
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
ENDOTRACHEL TUBE 6.5
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40201524
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
ENDOTRACHEL TUBE 7.0
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40201525
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
ENDOTRACHEL TUBE 7.5
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40201526
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
ENDOTRACHEL TUBE 8.0
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40201527
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
ENDOTRACHEL TUBE 8.5
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40201528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
ENDOTRACHEL TUBE 9.0
|
Facility
OP
|
$6.38
|
|
| Hospital Charge Code |
40201529
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.19
|
| Rate for Payer: Aetna Government |
$3.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.34
|
| Rate for Payer: Group Health Inc Commercial |
$3.19
|
| Rate for Payer: Group Health Inc Medicare |
$2.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.19
|
|
|
ENDOTRACHEL TUBE 9.5
|
Facility
OP
|
$7.38
|
|
| Hospital Charge Code |
40201530
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.69
|
| Rate for Payer: Aetna Government |
$3.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.02
|
| Rate for Payer: Group Health Inc Commercial |
$3.69
|
| Rate for Payer: Group Health Inc Medicare |
$2.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.69
|
|
|
ENDOTRACH TUBE
|
Facility
OP
|
$17.00
|
|
| Hospital Charge Code |
40207620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.50
|
| Rate for Payer: Aetna Government |
$8.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.56
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
IP
|
$107,863.90
|
|
|
Service Code
|
MS-DRG 266
|
| Min. Negotiated Rate |
$43,684.38 |
| Max. Negotiated Rate |
$107,863.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92,098.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93,944.91
|
| Rate for Payer: Aetna Government |
$93,944.91
|
| Rate for Payer: Brighton Health Commercial |
$90,568.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95,823.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$107,863.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$89,013.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$89,247.66
|
| Rate for Payer: EmblemHealth Commercial |
$53,560.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$93,944.91
|
| Rate for Payer: Group Health Inc Commercial |
$93,944.91
|
| Rate for Payer: Group Health Inc Medicare |
$93,944.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93,944.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43,684.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93,944.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93,944.91
|
| Rate for Payer: Wellcare Medicare |
$89,247.66
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
IP
|
$84,276.17
|
|
|
Service Code
|
MS-DRG 267
|
| Min. Negotiated Rate |
$34,876.60 |
| Max. Negotiated Rate |
$84,276.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71,958.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75,003.45
|
| Rate for Payer: Aetna Government |
$75,003.45
|
| Rate for Payer: Brighton Health Commercial |
$70,762.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76,503.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84,276.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69,548.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$71,253.28
|
| Rate for Payer: EmblemHealth Commercial |
$41,847.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$75,003.45
|
| Rate for Payer: Group Health Inc Commercial |
$75,003.45
|
| Rate for Payer: Group Health Inc Medicare |
$75,003.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75,003.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34,876.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75,003.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75,003.45
|
| Rate for Payer: Wellcare Medicare |
$71,253.28
|
|
|
ENDOVENOUS LASER 1ST VEIN
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
41201184
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$310.33 |
| Max. Negotiated Rate |
$4,196.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$310.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$344.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
ENEMA SET
|
Facility
OP
|
$6.73
|
|
| Hospital Charge Code |
40201510
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
|
ENERGEN ICD
|
Facility
OP
|
$38,500.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
66574084
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$40,425.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,175.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,000.00
|
| Rate for Payer: Aetna Government |
$5,000.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,137.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$40,425.00
|
| Rate for Payer: Group Health Inc Commercial |
$19,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$13,475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,025.00
|
|
|
ENERGEN ICD-DF4-VR
|
Facility
OP
|
$36,000.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
66526904
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,988.80 |
| Max. Negotiated Rate |
$37,800.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,800.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,988.80
|
| Rate for Payer: Aetna Government |
$3,988.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,700.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,800.00
|
| Rate for Payer: Group Health Inc Commercial |
$18,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$12,600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,000.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,400.00
|
|
|
ENERGEN ICD IS-1DF-1-VR
|
Facility
IP
|
$36,000.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
66524665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,000.00 |
| Max. Negotiated Rate |
$18,000.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,000.00
|
|
|
ENERGEN ICD IS-1DF-1-VR
|
Facility
OP
|
$36,000.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
66524665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.46 |
| Max. Negotiated Rate |
$37,800.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,800.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$510.46
|
| Rate for Payer: Aetna Government |
$510.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,700.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,800.00
|
| Rate for Payer: Group Health Inc Commercial |
$18,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$12,600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,000.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,400.00
|
|
|
ENFAMIL HUMAN MLK FORTIFID .71G
|
Facility
OP
|
$0.45
|
|
| Hospital Charge Code |
41640255
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| 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 |
$0.36
|
| 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
|
|
|
ENFAMIL HUMAN MLK FORTIFID .71G
|
Facility
OP
|
$0.45
|
|
| Hospital Charge Code |
41650255
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| 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 |
$0.36
|
| 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
|
|
|
ENFAMIL INFANT FORMULA W IRON
|
Facility
OP
|
$0.45
|
|
| Hospital Charge Code |
41650252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| 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 |
$0.36
|
| 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
|
|
|
ENFAMIL INFANT FORMULA W IRON
|
Facility
OP
|
$0.45
|
|
| Hospital Charge Code |
41640252
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| 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 |
$0.36
|
| 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
|
|
|
ENFAMIL PREMATURE 30 CAL
|
Facility
OP
|
$0.45
|
|
| Hospital Charge Code |
41650254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| 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 |
$0.36
|
| 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
|
|
|
ENFAMIL PREMATURE 30 CAL
|
Facility
OP
|
$0.45
|
|
| Hospital Charge Code |
41640254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.36 |
| 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 |
$0.36
|
| 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
|
|
