|
AEROSOL THERAPY QID AND PRN
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306103
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| 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: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| 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 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 Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare 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
|
|
|
AEROSOL THERAPY STAT
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40306101
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
AEROSOL THERAPY STAT
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40306101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| 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: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| 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 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 Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare 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
|
|
|
AEROSOL THERAPY TID
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306116
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
AEROSOL THERAPY TID
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306116
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| 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: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| 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 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 Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare 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
|
|
|
AEROSOL THERAPY TID/PRN
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306117
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
AEROSOL THERAPY TID/PRN
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306117
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| 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: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| 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 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 Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare 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
|
|
|
AEROSOL T-PIECE
|
Facility
|
OP
|
$35.44
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
40307401
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$26.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.10
|
| Rate for Payer: Group Health Inc Commercial |
$17.72
|
| Rate for Payer: Group Health Inc Medicare |
$12.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.72
|
|
|
AEROSOL TRACHEOSTOMY MASK
|
Facility
|
OP
|
$35.44
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
40305900
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$26.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.10
|
| Rate for Payer: Group Health Inc Commercial |
$17.72
|
| Rate for Payer: Group Health Inc Medicare |
$12.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.72
|
|
|
AESCULAP MIRROR LARYNGEAL7SIZE5
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
40200473
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.32
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$8.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
|
|
AFB CULTURE - NEGATIVE
|
Facility
|
OP
|
$36.53
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
40614015
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.61
|
| Rate for Payer: Aetna Government |
$14.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.23
|
| Rate for Payer: Brighton Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Cash Price |
$14.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.61
|
| Rate for Payer: EmblemHealth Commercial |
$14.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.00
|
| Rate for Payer: Group Health Inc Commercial |
$14.61
|
| Rate for Payer: Group Health Inc Medicare |
$14.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.61
|
| Rate for Payer: Healthfirst QHP |
$14.61
|
| Rate for Payer: Humana Medicare |
$14.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.61
|
| Rate for Payer: United Healthcare Commercial |
$13.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.69
|
| Rate for Payer: Wellcare Medicare |
$13.15
|
|
|
AFB CULTURE - NEGATIVE
|
Facility
|
IP
|
$36.53
|
|
|
Service Code
|
HCPCS 87118
|
| Hospital Charge Code |
40614015
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$14.61
|
|
|
AFB SMEAR
|
Facility
|
OP
|
$13.48
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
40614020
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.39
|
| Rate for Payer: Aetna Government |
$5.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.77
|
| Rate for Payer: Brighton Health Commercial |
$10.11
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.39
|
| Rate for Payer: EmblemHealth Commercial |
$5.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.39
|
| Rate for Payer: Group Health Inc Medicare |
$5.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.39
|
| Rate for Payer: Healthfirst QHP |
$5.39
|
| Rate for Payer: Humana Medicare |
$5.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare Commercial |
$6.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.31
|
| Rate for Payer: Wellcare Medicare |
$4.85
|
|
|
AFB SMEAR
|
Facility
|
IP
|
$13.48
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
40614020
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$5.39
|
|
|
AFB SPUTUM KIT
|
Facility
|
OP
|
$8.51
|
|
| Hospital Charge Code |
40207607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.26
|
| Rate for Payer: Aetna Government |
$4.26
|
| Rate for Payer: Brighton Health Commercial |
$6.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
|
|
AFB TISSUE CONTROL SLIDES
|
Facility
|
OP
|
$10.83
|
|
| Hospital Charge Code |
64903692
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.42
|
| Rate for Payer: Aetna Government |
$5.42
|
| Rate for Payer: Brighton Health Commercial |
$8.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.36
|
| Rate for Payer: Group Health Inc Commercial |
$5.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.42
|
|
|
AFFIXUS FULL ANATOMY INST CASE
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,360.00 |
| Max. Negotiated Rate |
$2,360.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,360.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,360.00
|
|
|
AFFIXUS FULL ANATOMY INST CASE
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,956.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,596.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,832.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,714.00
|
| Rate for Payer: EmblemHealth Commercial |
$2,360.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,956.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,360.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,652.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,360.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,360.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,068.00
|
|
|
AFFIXUS INSTRUMENT CASE 1
|
Facility
|
OP
|
$5,520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$5,796.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,036.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$3,312.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,760.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,174.00
|
| Rate for Payer: EmblemHealth Commercial |
$2,760.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,796.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,760.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,932.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,760.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,760.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,588.00
|
|
|
AFFIXUS INSTRUMENT CASE 1
|
Facility
|
IP
|
$5,520.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,760.00 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,760.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,760.00
|
|
|
AFFIXUS INSTRUMENT CASE 2
|
Facility
|
IP
|
$4,512.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,256.00 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,256.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,256.00
|
|
|
AFFIXUS INSTRUMENT CASE 2
|
Facility
|
OP
|
$4,512.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,737.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,481.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,707.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,256.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,594.40
|
| Rate for Payer: EmblemHealth Commercial |
$2,256.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,737.60
|
| Rate for Payer: Group Health Inc Commercial |
$2,256.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,579.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,256.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,256.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,932.80
|
|
|
AFLURIA SYRINGE
|
Facility
|
IP
|
$24.90
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
41647080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.45
|
|
|
AFLURIA SYRINGE
|
Facility
|
OP
|
$24.90
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
41647080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$1,267.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.69
|
| Rate for Payer: Aetna Government |
$17.69
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.67
|
| Rate for Payer: Amida Care Medicaid |
$12.67
|
| Rate for Payer: Brighton Health Commercial |
$14.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,267.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.30
|
| Rate for Payer: Group Health Inc Commercial |
$12.45
|
| Rate for Payer: Group Health Inc Medicare |
$8.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.67
|
| Rate for Payer: Healthfirst Essential Plan |
$28.51
|
| Rate for Payer: Healthfirst QHP |
$12.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.67
|
| Rate for Payer: SOMOS Essential |
$12.67
|
| Rate for Payer: United Healthcare Commercial |
$12.88
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$28.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.94
|
| Rate for Payer: United Healthcare Medicaid |
$12.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.67
|
|
|
AFLURIA SYRINGE
|
Facility
|
IP
|
$24.90
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
41657080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.45
|
|
