|
DIALYSIS MAINTENANCE IN/OUT
|
Facility
|
OP
|
$1,938.50
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
42901000
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$565.68 |
| Max. Negotiated Rate |
$1,550.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,066.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$808.11
|
| Rate for Payer: Aetna Government |
$808.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$565.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$565.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$565.68
|
| Rate for Payer: Brighton Health Commercial |
$1,453.88
|
| Rate for Payer: Cash Price |
$808.11
|
| Rate for Payer: Cash Price |
$808.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$808.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,550.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,318.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$808.11
|
| Rate for Payer: EmblemHealth Commercial |
$808.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$719.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$808.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$719.22
|
| Rate for Payer: Group Health Inc Commercial |
$808.11
|
| Rate for Payer: Group Health Inc Medicare |
$808.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$969.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$808.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$686.89
|
| Rate for Payer: Healthfirst QHP |
$808.11
|
| Rate for Payer: Humana Medicare |
$824.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$808.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$808.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$808.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$646.49
|
| Rate for Payer: Wellcare Medicare |
$767.70
|
|
|
DIALYSIS MAINTENANCE IN/OUT
|
Facility
|
IP
|
$1,938.50
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
42901000
|
|
Hospital Revenue Code
|
801
|
| Rate for Payer: Cash Price |
$808.11
|
|
|
DIALYSIS ONE EVALUATION
|
Facility
|
IP
|
$1,065.48
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
42905341
|
|
Hospital Revenue Code
|
831
|
| Rate for Payer: Cash Price |
$512.19
|
|
|
DIALYSIS ONE EVALUATION
|
Facility
|
OP
|
$1,065.48
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
42905341
|
|
Hospital Revenue Code
|
831
|
| Min. Negotiated Rate |
$123.10 |
| Max. Negotiated Rate |
$799.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$586.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$512.19
|
| Rate for Payer: Aetna Government |
$512.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$276.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$276.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$123.10
|
| Rate for Payer: Amida Care Medicaid |
$123.10
|
| Rate for Payer: Brighton Health Commercial |
$799.11
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$512.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$620.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$527.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$512.19
|
| Rate for Payer: EmblemHealth Commercial |
$445.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$512.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.00
|
| Rate for Payer: Group Health Inc Commercial |
$650.00
|
| Rate for Payer: Group Health Inc Medicare |
$435.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$512.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.10
|
| Rate for Payer: Healthfirst Essential Plan |
$276.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$435.36
|
| Rate for Payer: Healthfirst QHP |
$123.10
|
| Rate for Payer: Humana Medicare |
$522.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$512.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.10
|
| Rate for Payer: SOMOS Essential |
$276.98
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$276.98
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$135.41
|
| Rate for Payer: United Healthcare Medicaid |
$123.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$512.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$512.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$409.75
|
| Rate for Payer: Wellcare Medicare |
$370.00
|
|
|
DIANEAL 1.5 1LTR BAG
|
Facility
|
OP
|
$15.95
|
|
| Hospital Charge Code |
42905270
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.98
|
| Rate for Payer: Aetna Government |
$7.98
|
| Rate for Payer: Brighton Health Commercial |
$11.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.85
|
| Rate for Payer: Group Health Inc Commercial |
$7.98
|
| Rate for Payer: Group Health Inc Medicare |
$5.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.98
|
|
|
DIANEAL 1.5 2LTR BAG
|
Facility
|
OP
|
$22.32
|
|
| Hospital Charge Code |
42905280
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.16
|
| Rate for Payer: Aetna Government |
$11.16
|
| Rate for Payer: Brighton Health Commercial |
$16.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.18
|
| Rate for Payer: Group Health Inc Commercial |
$11.16
|
| Rate for Payer: Group Health Inc Medicare |
$7.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.16
|
|
|
DIANEAL 1.5 3LTR BAG
|
Facility
|
OP
|
$29.77
|
|
| Hospital Charge Code |
42905290
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$23.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.88
|
| Rate for Payer: Aetna Government |
$14.88
|
| Rate for Payer: Brighton Health Commercial |
$22.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
| Rate for Payer: Group Health Inc Commercial |
$14.88
|
| Rate for Payer: Group Health Inc Medicare |
$10.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.88
|
|
|
DIANEAL 2.5 1LTR BAG
|
Facility
|
OP
|
$16.31
|
|
| Hospital Charge Code |
42905271
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.16
|
| Rate for Payer: Aetna Government |
$8.16
|
| Rate for Payer: Brighton Health Commercial |
$12.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.09
|
| Rate for Payer: Group Health Inc Commercial |
$8.16
|
| Rate for Payer: Group Health Inc Medicare |
$5.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.16
|
|
|
DIANEAL 2.5 2LTR BAG
|
Facility
|
OP
|
$23.04
|
|
| Hospital Charge Code |
42905281
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.52
|
| Rate for Payer: Aetna Government |
$11.52
|
| Rate for Payer: Brighton Health Commercial |
$17.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.67
|
| Rate for Payer: Group Health Inc Commercial |
$11.52
|
| Rate for Payer: Group Health Inc Medicare |
$8.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.52
|
|
|
DIANEAL 2.5 3LTR BAG
|
Facility
|
OP
|
$30.48
|
|
| Hospital Charge Code |
42905291
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.24
|
| Rate for Payer: Aetna Government |
$15.24
|
| Rate for Payer: Brighton Health Commercial |
$22.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.73
|
| Rate for Payer: Group Health Inc Commercial |
$15.24
|
| Rate for Payer: Group Health Inc Medicare |
$10.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.24
|
|
|
DIANEAL 4.25 1LTR BAG
|
Facility
|
OP
|
$16.65
|
|
| Hospital Charge Code |
42905272
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.32
|
| Rate for Payer: Aetna Government |
$8.32
|
| Rate for Payer: Brighton Health Commercial |
$12.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.32
|
| Rate for Payer: Group Health Inc Commercial |
$8.32
|
| Rate for Payer: Group Health Inc Medicare |
$5.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.32
|
|
|
DIANEAL 4.25 2LTR BAG
|
Facility
|
OP
|
$23.74
|
|
| Hospital Charge Code |
42905282
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$18.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.87
|
| Rate for Payer: Aetna Government |
$11.87
|
| Rate for Payer: Brighton Health Commercial |
$17.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.14
|
| Rate for Payer: Group Health Inc Commercial |
$11.87
|
| Rate for Payer: Group Health Inc Medicare |
$8.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.87
|
|
|
DIANEAL 4.25 3LTR BAG
|
Facility
|
OP
|
$31.19
|
|
| Hospital Charge Code |
42905292
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$24.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.60
|
| Rate for Payer: Aetna Government |
$15.60
|
| Rate for Payer: Brighton Health Commercial |
$23.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.21
|
| Rate for Payer: Group Health Inc Commercial |
$15.60
|
| Rate for Payer: Group Health Inc Medicare |
$10.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.60
|
|
|
DIANEAL 4-TYPE SOL ADM. SET
|
Facility
|
OP
|
$38.99
|
|
| Hospital Charge Code |
40509822
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.50
|
| Rate for Payer: Aetna Government |
$19.50
|
| Rate for Payer: Brighton Health Commercial |
$29.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.51
|
| Rate for Payer: Group Health Inc Commercial |
$19.50
|
| Rate for Payer: Group Health Inc Medicare |
$13.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.50
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
DIANEAL SOL. 1.5% 2000CC
|
Facility
|
OP
|
$46.78
|
|
| Hospital Charge Code |
40509793
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.39
|
| Rate for Payer: Aetna Government |
$23.39
|
| Rate for Payer: Brighton Health Commercial |
$35.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.81
|
| Rate for Payer: Group Health Inc Commercial |
$23.39
|
| Rate for Payer: Group Health Inc Medicare |
$16.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.39
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
DIANEAL SOL. 4.25% 2000CC
|
Facility
|
OP
|
$48.91
|
|
| Hospital Charge Code |
40509794
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.46
|
| Rate for Payer: Aetna Government |
$24.46
|
| Rate for Payer: Brighton Health Commercial |
$36.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.26
|
| Rate for Payer: Group Health Inc Commercial |
$24.46
|
| Rate for Payer: Group Health Inc Medicare |
$17.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.46
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
DIAPER ADULT LARGE ATTENDS
|
Facility
|
OP
|
$0.78
|
|
| Hospital Charge Code |
64901140
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
|
|
DIAPER ADULT MEDIUM
|
Facility
|
OP
|
$0.59
|
|
| Hospital Charge Code |
64902578
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Brighton Health Commercial |
$0.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
|
|
DIAPER ADULT XX-LARGE
|
Facility
|
OP
|
$1.43
|
|
| Hospital Charge Code |
64901449
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.72
|
| Rate for Payer: Aetna Government |
$0.72
|
| Rate for Payer: Brighton Health Commercial |
$1.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Group Health Inc Commercial |
$0.72
|
| Rate for Payer: Group Health Inc Medicare |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.72
|
|
|
DIAPER PAMPERS NEWBORN
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
64901735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
|
|
DIAPER PAMPERS SIZE 4
|
Facility
|
OP
|
$0.12
|
|
| Hospital Charge Code |
64902384
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
|
|
DIAPER PAMPERS SIZE 5
|
Facility
|
OP
|
$0.27
|
|
| Hospital Charge Code |
64902386
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
|
|
DIAPER PAMPERS SZ 1 INFANT
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
64901921
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
|
|
DIAPER PAMPERS SZ 3 CRAWLER
|
Facility
|
OP
|
$0.12
|
|
| Hospital Charge Code |
64901720
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
|
|
DIAPER PREMATURE
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
64901734
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
|
