|
CULTURE, SPORE
|
Facility
|
IP
|
$21.55
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
40614220
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$8.62
|
|
|
CULTURE, SPORE
|
Facility
|
OP
|
$21.55
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
40614220
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.03
|
| Rate for Payer: Brighton Health Commercial |
$16.16
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Humana Medicare |
$8.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$10.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.90
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
CULTURE, STOOL
|
Facility
|
OP
|
$23.60
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
40614200
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.44
|
| Rate for Payer: Aetna Government |
$9.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.61
|
| Rate for Payer: Brighton Health Commercial |
$17.70
|
| Rate for Payer: Cash Price |
$9.44
|
| Rate for Payer: Cash Price |
$9.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.44
|
| Rate for Payer: EmblemHealth Commercial |
$9.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.40
|
| Rate for Payer: Group Health Inc Commercial |
$9.44
|
| Rate for Payer: Group Health Inc Medicare |
$9.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.44
|
| Rate for Payer: Healthfirst QHP |
$9.44
|
| Rate for Payer: Humana Medicare |
$9.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.44
|
| Rate for Payer: United Healthcare Commercial |
$11.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.55
|
| Rate for Payer: Wellcare Medicare |
$8.50
|
|
|
CULTURE, STOOL
|
Facility
|
IP
|
$23.60
|
|
|
Service Code
|
HCPCS 87046
|
| Hospital Charge Code |
40614200
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$9.44
|
|
|
CULTURE TYPE IMMUNOFLUORESC
|
Facility
|
OP
|
$13.93
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
40619613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.90
|
| Rate for Payer: Brighton Health Commercial |
$10.45
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.57
|
| Rate for Payer: EmblemHealth Commercial |
$5.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.96
|
| Rate for Payer: Group Health Inc Commercial |
$5.57
|
| Rate for Payer: Group Health Inc Medicare |
$5.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.57
|
| Rate for Payer: Healthfirst QHP |
$5.57
|
| Rate for Payer: Humana Medicare |
$5.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.57
|
| Rate for Payer: United Healthcare Commercial |
$7.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.46
|
| Rate for Payer: Wellcare Medicare |
$5.01
|
|
|
CULTURE TYPE IMMUNOFLUORESC
|
Facility
|
IP
|
$13.93
|
|
|
Service Code
|
HCPCS 87140
|
| Hospital Charge Code |
40619613
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.57
|
|
|
CULTURE TYPE IMMUNOLOGIC
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
40614324
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
CULTURE TYPE IMMUNOLOGIC
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 87147
|
| Hospital Charge Code |
40614324
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
CULTURE, URINE
|
Facility
|
IP
|
$20.18
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
40614185
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$8.07
|
|
|
CULTURE, URINE
|
Facility
|
OP
|
$20.18
|
|
|
Service Code
|
HCPCS 87086
|
| Hospital Charge Code |
40614185
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$15.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.07
|
| Rate for Payer: Aetna Government |
$8.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.65
|
| Rate for Payer: Brighton Health Commercial |
$15.14
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Cash Price |
$8.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.07
|
| Rate for Payer: EmblemHealth Commercial |
$8.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.18
|
| Rate for Payer: Group Health Inc Commercial |
$8.07
|
| Rate for Payer: Group Health Inc Medicare |
$8.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.07
|
| Rate for Payer: Healthfirst QHP |
$8.07
|
| Rate for Payer: Humana Medicare |
$8.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.07
|
| Rate for Payer: United Healthcare Commercial |
$10.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.46
|
| Rate for Payer: Wellcare Medicare |
$7.26
|
|
|
CUP ACETABULAR 28MM BI-POL
|
Facility
|
OP
|
$2,072.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,175.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,139.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,243.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,036.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,191.40
|
| Rate for Payer: EmblemHealth Commercial |
$1,036.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,175.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,036.00
|
| Rate for Payer: Group Health Inc Medicare |
$725.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,036.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,036.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,346.80
|
|
|
CUP ACETABULAR 28MM BI-POL
|
Facility
|
IP
|
$2,072.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.00 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,036.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,036.00
|
|
|
CUP ACET OSTEOTOME
|
Facility
|
OP
|
$1,321.25
|
|
| Hospital Charge Code |
64907268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$462.44 |
| Max. Negotiated Rate |
$1,057.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$726.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$660.62
|
| Rate for Payer: Aetna Government |
$660.62
|
| Rate for Payer: Brighton Health Commercial |
$990.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,057.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$898.45
|
| Rate for Payer: Group Health Inc Commercial |
$660.62
|
| Rate for Payer: Group Health Inc Medicare |
$462.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$660.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$660.62
|
|
|
CUP,CERVICAL,VCARE,SM 32MM
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
64902648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.00
|
| Rate for Payer: Aetna Government |
$110.00
|
| Rate for Payer: Brighton Health Commercial |
$165.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$149.60
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
|
|
CUP HIP RIMFIT
|
Facility
|
OP
|
$7,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$7,384.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,868.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$4,219.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,516.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,044.04
|
| Rate for Payer: EmblemHealth Commercial |
$3,516.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,384.78
|
| Rate for Payer: Group Health Inc Commercial |
$3,516.56
|
| Rate for Payer: Group Health Inc Medicare |
$2,461.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,516.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,516.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,571.53
|
|
|
CUP HIP RIMFIT
|
Facility
|
IP
|
$7,033.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,516.56 |
| Max. Negotiated Rate |
$3,516.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,516.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,516.56
|
|
|
CUP PRIME TRIT CLSTR H 48MM
|
Facility
|
OP
|
$8,185.50
|
|
| Hospital Charge Code |
64905732
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,864.92 |
| Max. Negotiated Rate |
$6,548.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,502.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,092.75
|
| Rate for Payer: Aetna Government |
$4,092.75
|
| Rate for Payer: Brighton Health Commercial |
$6,139.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,548.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,566.14
|
| Rate for Payer: Group Health Inc Commercial |
$4,092.75
|
| Rate for Payer: Group Health Inc Medicare |
$2,864.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,092.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,092.75
|
|
|
CUP RESTOR ADM INST
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,687.50 |
| Max. Negotiated Rate |
$1,687.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,687.50
|
|
|
CUP RESTOR ADM INST
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,543.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,856.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,025.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,687.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,940.62
|
| Rate for Payer: EmblemHealth Commercial |
$1,687.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,543.75
|
| Rate for Payer: Group Health Inc Commercial |
$1,687.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,181.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,687.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,687.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,193.75
|
|
|
CUP STOOL
|
Facility
|
OP
|
$0.34
|
|
| Hospital Charge Code |
64901867
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna Government |
$0.17
|
| Rate for Payer: Brighton Health Commercial |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
|
|
CUPTO SHEET
|
Facility
|
OP
|
$28.35
|
|
| Hospital Charge Code |
40200928
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$22.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.18
|
| Rate for Payer: Aetna Government |
$14.18
|
| Rate for Payer: Brighton Health Commercial |
$21.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.28
|
| Rate for Payer: Group Health Inc Commercial |
$14.18
|
| Rate for Payer: Group Health Inc Medicare |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.18
|
|
|
CUP TRIDNT CLUSTERHOLE
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,806.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,993.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,175.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,812.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,084.38
|
| Rate for Payer: EmblemHealth Commercial |
$1,812.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,806.25
|
| Rate for Payer: Group Health Inc Commercial |
$1,812.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,268.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,812.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,812.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,356.25
|
|
|
CUP TRIDNT CLUSTERHOLE
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907204
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.50 |
| Max. Negotiated Rate |
$1,812.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,812.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,812.50
|
|
|
CURAD PACK STRIP 1 IN X 5 YRD
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
40204260
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.00
|
| Rate for Payer: Aetna Government |
$50.00
|
| Rate for Payer: Brighton Health Commercial |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
CURETTAGE, POSTPARTUM
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59160
|
| Hospital Charge Code |
40052247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
