|
FILTERS FOR OFP FLUSHING PUMP
|
Facility
OP
|
$18.35
|
|
| Hospital Charge Code |
64903514
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$14.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.18
|
| Rate for Payer: Aetna Government |
$9.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.48
|
| Rate for Payer: Group Health Inc Commercial |
$9.18
|
| Rate for Payer: Group Health Inc Medicare |
$6.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.18
|
|
|
FILTER SQUARE 9X9 W/INDICATOR
|
Facility
OP
|
$0.14
|
|
| Hospital Charge Code |
64905214
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
|
|
FILTER STERIL CONTAIN MINI 9X4
|
Facility
OP
|
$0.08
|
|
| Hospital Charge Code |
64903839
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
FILTER STERILIZATION 9 X 9
|
Facility
OP
|
$0.13
|
|
| Hospital Charge Code |
64903837
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
|
|
FILTER STRAW, 1-3/4, 5 MICR
|
Facility
OP
|
$0.94
|
|
| Hospital Charge Code |
64906215
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.47
|
| Rate for Payer: Aetna Government |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.64
|
| Rate for Payer: Group Health Inc Commercial |
$0.47
|
| Rate for Payer: Group Health Inc Medicare |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.47
|
|
|
FILTER VAC DRAEGER
|
Facility
OP
|
$41.44
|
|
| Hospital Charge Code |
64906826
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.72
|
| Rate for Payer: Aetna Government |
$20.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.18
|
| Rate for Payer: Group Health Inc Commercial |
$20.72
|
| Rate for Payer: Group Health Inc Medicare |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.72
|
|
|
FILTER,VAPOR MANAGEMENT
|
Facility
OP
|
$1,212.50
|
|
| Hospital Charge Code |
64903854
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$424.38 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$666.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$606.25
|
| Rate for Payer: Aetna Government |
$606.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$970.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$824.50
|
| Rate for Payer: Group Health Inc Commercial |
$606.25
|
| Rate for Payer: Group Health Inc Medicare |
$424.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$606.25
|
|
|
FILTER VENA CAVA GREENFLD FEMORAL
|
Facility
IP
|
$2,265.90
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
64901089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.95 |
| Max. Negotiated Rate |
$1,132.95 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,132.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,132.95
|
|
|
FILTER VENA CAVA GREENFLD FEMORAL
|
Facility
OP
|
$2,265.90
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
64901089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$2,379.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,246.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.08
|
| Rate for Payer: Aetna Government |
$57.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,132.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,302.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,379.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,132.95
|
| Rate for Payer: Group Health Inc Medicare |
$793.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,132.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,132.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,472.84
|
|
|
FILTER VENA CAVA PERM TRAPEASE
|
Facility
IP
|
$2,380.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
40202360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.00 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,190.00
|
|
|
FILTER VENA CAVA PERM TRAPEASE
|
Facility
OP
|
$2,380.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
40202360
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$2,499.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,309.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.08
|
| Rate for Payer: Aetna Government |
$57.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,190.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,368.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,499.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,190.00
|
| Rate for Payer: Group Health Inc Medicare |
$833.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,190.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,547.00
|
|
|
FILTER VENA CAVA PERM TRAPEASE
|
Facility
OP
|
$2,988.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
64901263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$3,137.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,643.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.08
|
| Rate for Payer: Aetna Government |
$57.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,494.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,718.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,137.40
|
| Rate for Payer: Group Health Inc Commercial |
$1,494.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,045.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,494.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,494.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,942.20
|
|
|
FILTER VENA CAVA PERM TRAPEASE
|
Facility
IP
|
$2,988.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
64901263
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.00 |
| Max. Negotiated Rate |
$1,494.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,494.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,494.00
|
|
|
FILTER WATER SEDIMENT REPLACE
|
Facility
OP
|
$711.47
|
|
| Hospital Charge Code |
64903672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$249.01 |
| Max. Negotiated Rate |
$569.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$391.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$355.74
|
| Rate for Payer: Aetna Government |
$355.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$569.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$483.80
|
| Rate for Payer: Group Health Inc Commercial |
$355.74
|
| Rate for Payer: Group Health Inc Medicare |
$249.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.74
|
|
|
FILTER WATER SEDIMENT REPLACEMENT
|
Facility
OP
|
$13.42
|
|
| Hospital Charge Code |
64902962
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.71
|
| Rate for Payer: Aetna Government |
$6.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.13
|
| Rate for Payer: Group Health Inc Commercial |
$6.71
|
| Rate for Payer: Group Health Inc Medicare |
$4.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.71
|
|
|
FINELINE II STEROX BIPOL PAS STER
|
Facility
OP
|
$1,687.50
|
|
| Hospital Charge Code |
64903842
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$590.62 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$928.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$843.75
|
| Rate for Payer: Aetna Government |
$843.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,350.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,147.50
|
| Rate for Payer: Group Health Inc Commercial |
$843.75
|
| Rate for Payer: Group Health Inc Medicare |
$590.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$843.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$843.75
|
|
|
FINELINE II STEROX LEAD #4457
|
Facility
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66573253
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,417.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$742.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.92
|
| Rate for Payer: Aetna Government |
$98.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$675.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$776.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,417.50
|
| Rate for Payer: Group Health Inc Commercial |
$675.00
|
| Rate for Payer: Group Health Inc Medicare |
$472.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$675.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$675.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$877.50
|
|
|
Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.17
|
| Rate for Payer: Aetna Government |
$42.17
|
| 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 |
$53.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.21
|
|
|
Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.17
|
| Rate for Payer: Aetna Government |
$42.17
|
| 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: Fidelis CHP/HARP/Medicaid |
$53.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.21
|
|
|
Fine needle aspiration biopsy, including ultrasound guidance; first lesion
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$79.32 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
Fine needle aspiration biopsy, including ultrasound guidance; first lesion
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.32 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
FINE NEEDLE ASP W/INTERP & REP
|
Facility
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Hospital Charge Code |
40635476
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$52.44 |
| Max. Negotiated Rate |
$119.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.92
|
| Rate for Payer: Aetna Government |
$74.92
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$101.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.09
|
| Rate for Payer: Group Health Inc Commercial |
$74.92
|
| Rate for Payer: Group Health Inc Medicare |
$52.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.66
|
|
|
FINE NEEDLE ASP W/INTERP & REP
|
Facility
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
40635475
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$192.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.66
|
| Rate for Payer: Aetna Government |
$62.66
|
| Rate for Payer: Brighton Health Commercial |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.77
|
| Rate for Payer: Group Health Inc Commercial |
$62.66
|
| Rate for Payer: Group Health Inc Medicare |
$62.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare |
$56.39
|
|
|
FINE NEEDLE ASP W/O IMAGE
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
30305940
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.03 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$461.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
FINE NEEDLE ASP W/O IMAGE
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
30105940
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.03 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$461.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
