|
Fecal Pouch
|
Facility
OP
|
$29.06
|
|
| Hospital Charge Code |
40201750
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.53
|
| Rate for Payer: Aetna Government |
$14.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.76
|
| Rate for Payer: Group Health Inc Commercial |
$14.53
|
| Rate for Payer: Group Health Inc Medicare |
$10.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.53
|
|
|
FECES CULTURE AEROBIC BACT
|
Facility
OP
|
$23.60
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
40614311
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$15.00 |
| 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: 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 CHP/HARP/Medicaid |
$8.50
|
| 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 CHP/FHP/Medicaid |
$9.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.44
|
| Rate for Payer: Healthfirst QHP |
$9.44
|
| Rate for Payer: Senior Whole Health 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
|
|
|
FEEDING AID
|
Facility
OP
|
$1,087.50
|
|
|
Service Code
|
HCPCS D5951
|
| Hospital Charge Code |
42301325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$598.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$315.16
|
| Rate for Payer: Aetna Government |
$315.16
|
| 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: Group Health Inc Commercial |
$543.75
|
| Rate for Payer: Group Health Inc Medicare |
$380.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$543.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$543.75
|
|
|
FEEDING GASTORSTOMY LAP
|
Facility
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
40010930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$670.45 |
| Max. Negotiated Rate |
$7,320.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$670.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$744.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
FEEDING JEJUNOSTOMY
|
Facility
OP
|
$407.65
|
|
|
Service Code
|
HCPCS 44015
|
| Hospital Charge Code |
40019815
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.68 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.87
|
| Rate for Payer: Aetna Government |
$169.87
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.86
|
| Rate for Payer: Group Health Inc Commercial |
$203.82
|
| Rate for Payer: Group Health Inc Medicare |
$142.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.18
|
|
|
FEEDING TRAY
|
Facility
OP
|
$18.78
|
|
| Hospital Charge Code |
40201810
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.39
|
| Rate for Payer: Aetna Government |
$9.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.77
|
| Rate for Payer: Group Health Inc Commercial |
$9.39
|
| Rate for Payer: Group Health Inc Medicare |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.39
|
|
|
FEEDING TUBE
|
Facility
OP
|
$2.28
|
|
| Hospital Charge Code |
40201811
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.14
|
| Rate for Payer: Aetna Government |
$1.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.14
|
|
|
FEEDING TUBE KIT
|
Facility
OP
|
$345.00
|
|
| Hospital Charge Code |
64903580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$189.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.50
|
| Rate for Payer: Aetna Government |
$172.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$276.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.60
|
| Rate for Payer: Group Health Inc Commercial |
$172.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.50
|
|
|
FEES BY VIDEO RECORDING
|
Facility
OP
|
$198.45
|
|
|
Service Code
|
HCPCS 92612
|
| Hospital Charge Code |
41905000
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$58.95
|
| Rate for Payer: Aetna Government |
$58.95
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.78
|
| Rate for Payer: Group Health Inc Commercial |
$99.22
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.42
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
FEEST
|
Facility
OP
|
$289.38
|
|
|
Service Code
|
HCPCS 92616
|
| Hospital Charge Code |
41905009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$159.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.55
|
| Rate for Payer: Aetna Government |
$87.55
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.70
|
| Rate for Payer: Group Health Inc Commercial |
$144.69
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.11
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
FEES- VIDEO WITHOUT SWALLOW EVAL
|
Facility
OP
|
$194.73
|
|
|
Service Code
|
HCPCS 92614
|
| Hospital Charge Code |
41905001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$58.63
|
| Rate for Payer: Aetna Government |
$58.63
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.37
|
| Rate for Payer: Group Health Inc Commercial |
$97.36
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.97
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
FELT,ADHESIVE,1/4
|
Facility
OP
|
$93.52
|
|
| Hospital Charge Code |
64903350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.76
|
| Rate for Payer: Aetna Government |
$46.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.59
|
| Rate for Payer: Group Health Inc Commercial |
$46.76
|
| Rate for Payer: Group Health Inc Medicare |
$32.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.76
|
|
|
FELT POLYESTER 1X1
|
Facility
OP
|
$42.00
|
|
| Hospital Charge Code |
40200979
|
|
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
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
IP
|
$27,346.32
|
|
|
Service Code
|
MS-DRG 748
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$27,346.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,715.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,810.12
|
| Rate for Payer: Aetna Government |
$26,810.12
|
| Rate for Payer: Brighton Health Commercial |
$20,371.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,346.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,261.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,021.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,469.61
|
| Rate for Payer: EmblemHealth Commercial |
$12,047.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,810.12
|
| Rate for Payer: Group Health Inc Commercial |
$1,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$26,810.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,810.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,466.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,810.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,810.12
|
| Rate for Payer: Wellcare Medicare |
$25,469.61
|
|
|
FEM ANTVRT GMRS
|
Facility
OP
|
$16,897.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$17,742.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,293.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,448.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,716.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,742.38
|
| Rate for Payer: Group Health Inc Commercial |
$8,448.75
|
| Rate for Payer: Group Health Inc Medicare |
$5,914.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,448.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,448.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10,983.38
|
|
|
FEM ANTVRT GMRS
|
Facility
IP
|
$16,897.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907270
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,448.75 |
| Max. Negotiated Rate |
$8,448.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,448.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,448.75
|
|
|
FEM CMNTD EON
|
Facility
OP
|
$7,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$7,612.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,987.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,625.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,168.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,612.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,625.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,537.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,625.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,712.50
|
|
|
FEM CMNTD EON
|
Facility
IP
|
$7,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.00 |
| Max. Negotiated Rate |
$3,625.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,625.00
|
|
|
FEM COMP TRI BDD
|
Facility
OP
|
$7,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$7,875.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,125.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,750.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,312.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,875.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,750.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,750.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,875.00
|
|
|
FEM COMP TRI BDD
|
Facility
IP
|
$7,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,750.00 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,750.00
|
|
|
FEM COMP TRI CMTD
|
Facility
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,462.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,337.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,125.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,443.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,462.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,125.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,487.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,762.50
|
|
|
FEM COMP TRI CMTD
|
Facility
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.00 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
|
|
FEM DIS MRH AUGMENT
|
Facility
OP
|
$2,377.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,496.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,307.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,188.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,367.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,496.38
|
| Rate for Payer: Group Health Inc Commercial |
$1,188.75
|
| Rate for Payer: Group Health Inc Medicare |
$832.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,188.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,188.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,545.38
|
|
|
FEM DIS MRH AUGMENT
|
Facility
IP
|
$2,377.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907255
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,188.75 |
| Max. Negotiated Rate |
$1,188.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,188.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,188.75
|
|
|
FEM DIST GMRS
|
Facility
IP
|
$24,347.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907272
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,173.75 |
| Max. Negotiated Rate |
$12,173.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,173.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,173.75
|
|
