|
FLYCOPYRROLATE 2MG 1ML INJ
|
Facility
IP
|
$2.00
|
|
| Hospital Charge Code |
41657182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
|
|
FLYCOPYRROLATE 2MG 1ML INJ
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41657182
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
FMR CMNTD PSN PS CMT CCR STD SZ7L
|
Facility
IP
|
$6,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,300.00 |
| Max. Negotiated Rate |
$3,300.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,300.00
|
|
|
FMR CMNTD PSN PS CMT CCR STD SZ7L
|
Facility
OP
|
$6,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,930.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,630.00
|
| 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 |
$3,300.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,795.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,930.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,300.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,310.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,290.00
|
|
|
FMS INTERFACE CABLE
|
Facility
OP
|
$3,500.00
|
|
| Hospital Charge Code |
64905792
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,925.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,750.00
|
| Rate for Payer: Aetna Government |
$1,750.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,380.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,750.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,750.00
|
|
|
FMUR PSN PS CMT CCR NRW SZ3 L
|
Facility
IP
|
$6,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,300.00 |
| Max. Negotiated Rate |
$3,300.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,300.00
|
|
|
FMUR PSN PS CMT CCR NRW SZ3 L
|
Facility
OP
|
$6,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,930.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,630.00
|
| 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 |
$3,300.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,795.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,930.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,300.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,310.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,290.00
|
|
|
FNA BX W/CT GDN 1ST LES
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
30307909
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.62 |
| 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: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$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: Fidelis CHP/HARP/Medicaid |
$115.62
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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
|
|
|
FNA BX W/CT GDN EA ADDL
|
Facility
OP
|
$923.79
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
30307910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.47 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.47
|
| Rate for Payer: Aetna Government |
$70.47
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$76.86
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.40
|
|
|
FNA BX W/FLUOR GDN 1ST LES
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
30307935
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.58 |
| 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: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$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: Fidelis CHP/HARP/Medicaid |
$94.58
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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
|
|
|
FNA BX W/FLUOR GDN EA ADDL
|
Facility
OP
|
$923.79
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
30307936
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.04
|
| Rate for Payer: Aetna Government |
$52.04
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$57.36
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.73
|
|
|
FNA BX W/MR GDN 1ST LES
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 10011
|
| Hospital Charge Code |
30307911
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| 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: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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
|
|
|
FNA BX W/MR GDN EA ADDL
|
Facility
OP
|
$923.79
|
|
|
Service Code
|
HCPCS 10012
|
| Hospital Charge Code |
30307912
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$234.84
|
| Rate for Payer: Aetna Government |
$234.84
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.90
|
|
|
FNA BX W/US GDN 1ST LES
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
30307905
|
|
Hospital Revenue Code
|
510
|
| 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: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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
|
|
|
FNA BX W/US GDN EA ADDL
|
Facility
OP
|
$923.79
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
30307934
|
|
Hospital Revenue Code
|
510
|
| 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: Brighton Health Commercial |
$233.00
|
| 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: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.21
|
|
|
FNA W/IMAGE
|
Facility
OP
|
$1,631.20
|
|
| Hospital Charge Code |
30107812
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$815.60
|
| Rate for Payer: Aetna Government |
$815.60
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$815.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
FNA W/O IMAGE
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
30301220
|
|
Hospital Revenue Code
|
510
|
| 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 |
$233.00
|
| 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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$66.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| 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
|
|
|
FOAM ONLY VAC WHITEFM LG
|
Facility
OP
|
$33.12
|
|
| Hospital Charge Code |
64901132
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.56
|
| Rate for Payer: Aetna Government |
$16.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.52
|
| Rate for Payer: Group Health Inc Commercial |
$16.56
|
| Rate for Payer: Group Health Inc Medicare |
$11.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.56
|
|
|
FOAM (ONLY)VAC WHITEFOAM SM
|
Facility
OP
|
$25.91
|
|
| Hospital Charge Code |
64901131
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$20.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.96
|
| Rate for Payer: Aetna Government |
$12.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.62
|
| Rate for Payer: Group Health Inc Commercial |
$12.96
|
| Rate for Payer: Group Health Inc Medicare |
$9.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.96
|
|
|
FOGARTY CATHETER
|
Facility
OP
|
$85.76
|
|
| Hospital Charge Code |
40207015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$68.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.88
|
| Rate for Payer: Aetna Government |
$42.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.32
|
| Rate for Payer: Group Health Inc Commercial |
$42.88
|
| Rate for Payer: Group Health Inc Medicare |
$30.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.88
|
|
|
FOGARTY CATHETERS
|
Facility
OP
|
$89.66
|
|
| Hospital Charge Code |
40000190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$71.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.83
|
| Rate for Payer: Aetna Government |
$44.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$71.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.97
|
| Rate for Payer: Group Health Inc Commercial |
$44.83
|
| Rate for Payer: Group Health Inc Medicare |
$31.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.83
|
|
|
FOG OUT ANTI-FOG SOL
|
Facility
OP
|
$23.95
|
|
| Hospital Charge Code |
40202193
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.98
|
| Rate for Payer: Aetna Government |
$11.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.29
|
| Rate for Payer: Group Health Inc Commercial |
$11.98
|
| Rate for Payer: Group Health Inc Medicare |
$8.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.98
|
|
|
FOLEY CAT 16 FR 5CC 3-WAY
|
Facility
OP
|
$41.11
|
|
| Hospital Charge Code |
40201836
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.56
|
| Rate for Payer: Aetna Government |
$20.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.95
|
| Rate for Payer: Group Health Inc Commercial |
$20.56
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.56
|
|
|
FOLEY CAT 18 FR 30CC 3-WAY
|
Facility
OP
|
$24.45
|
|
| Hospital Charge Code |
40201831
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$19.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.22
|
| Rate for Payer: Aetna Government |
$12.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.63
|
| Rate for Payer: Group Health Inc Commercial |
$12.22
|
| Rate for Payer: Group Health Inc Medicare |
$8.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.22
|
|
|
FOLEY CAT 18 FR 5CC 3-WAY
|
Facility
OP
|
$41.11
|
|
| Hospital Charge Code |
40201837
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$32.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.56
|
| Rate for Payer: Aetna Government |
$20.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.95
|
| Rate for Payer: Group Health Inc Commercial |
$20.56
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.56
|
|
