|
DRAIN/INJ MAJOR JOINT/BURSA
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
30105537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$342.51
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$393.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
DRAIN/INJ SMALL JOINT
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
42500132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$594.62
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: EmblemHealth Commercial |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| Rate for Payer: Group Health Inc Commercial |
$342.51
|
| Rate for Payer: Group Health Inc Medicare |
$342.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
DRAIN/INJ SMALL JOINT
|
Facility
|
IP
|
$792.83
|
|
|
Service Code
|
HCPCS 20600
|
| Hospital Charge Code |
42500132
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
DRAIN. OF SKIN ABCESS LEVEL 1 I&D
|
Facility
|
OP
|
$547.93
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
30300164
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$273.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
DRAIN. OF SKIN ABCESS LEVEL 1 I&D
|
Facility
|
IP
|
$547.93
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
30300164
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
DRAIN.OF SKIN ABCESS LEVEL 1 I&D
|
Facility
|
IP
|
$547.93
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
30103207
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
DRAIN.OF SKIN ABCESS LEVEL 1 I&D
|
Facility
|
OP
|
$547.93
|
|
|
Service Code
|
HCPCS 10060
|
| Hospital Charge Code |
30103207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$231.52
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$273.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
DRAIN PENROSE 1/2 LATEX STERILE
|
Facility
|
OP
|
$2.80
|
|
| Hospital Charge Code |
64901967
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.40
|
| Rate for Payer: Aetna Government |
$1.40
|
| Rate for Payer: Brighton Health Commercial |
$2.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.40
|
|
|
DRAIN PENROSE 1/4 LATEX STERILE
|
Facility
|
OP
|
$2.45
|
|
| Hospital Charge Code |
64901954
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.22
|
| Rate for Payer: Aetna Government |
$1.22
|
| Rate for Payer: Brighton Health Commercial |
$1.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
|
|
DRAIN PENROSE 1 LATEX STERILE
|
Facility
|
OP
|
$2.80
|
|
| Hospital Charge Code |
64901984
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.40
|
| Rate for Payer: Aetna Government |
$1.40
|
| Rate for Payer: Brighton Health Commercial |
$2.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.40
|
|
|
DRAIN, PENROSE, 3/4,18LONG
|
Facility
|
OP
|
$2.79
|
|
| Hospital Charge Code |
64901961
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.40
|
| Rate for Payer: Aetna Government |
$1.40
|
| Rate for Payer: Brighton Health Commercial |
$2.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.40
|
|
|
DRAIN SHOULDER BURSA
|
Facility
|
OP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 23031
|
| Hospital Charge Code |
40029407
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,267.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,300.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,300.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,300.17
|
| Rate for Payer: Brighton Health Commercial |
$5,267.51
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| 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 |
$3,285.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,285.96
|
| Rate for Payer: Group Health Inc Medicare |
$3,285.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,793.07
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: Humana Medicare |
$3,351.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
DRAIN SHOULDER BURSA
|
Facility
|
IP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 23031
|
| Hospital Charge Code |
40029407
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,285.96
|
|
|
DRAIN SKENE'S GLAND ABSESS OR CYS
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 53060
|
| Hospital Charge Code |
30105306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,355.42
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| 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 |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
DRAIN SKENE'S GLAND ABSESS OR CYS
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 53060
|
| Hospital Charge Code |
30105306
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
DRAIN T-TUBE XEAY OPAQUE 16FR
|
Facility
|
OP
|
$24.64
|
|
| Hospital Charge Code |
40200418
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.32
|
| Rate for Payer: Aetna Government |
$12.32
|
| Rate for Payer: Brighton Health Commercial |
$18.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.32
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.32
|
|
|
DRAIN T-TUBE XRAY OPAQUE 12FR
|
Facility
|
OP
|
$74.45
|
|
| Hospital Charge Code |
40200416
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$59.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.22
|
| Rate for Payer: Aetna Government |
$37.22
|
| Rate for Payer: Brighton Health Commercial |
$55.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.63
|
| Rate for Payer: Group Health Inc Commercial |
$37.22
|
| Rate for Payer: Group Health Inc Medicare |
$26.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.22
|
|
|
DRAIN T-TUBE XRAY OPAQUE 14FR
|
Facility
|
OP
|
$24.64
|
|
| Hospital Charge Code |
40200417
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.32
|
| Rate for Payer: Aetna Government |
$12.32
|
| Rate for Payer: Brighton Health Commercial |
$18.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.32
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.32
|
|
|
DRAIN T-TUBE XRAY OPAQUE 8FR
|
Facility
|
OP
|
$24.66
|
|
| Hospital Charge Code |
40202186
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$19.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.33
|
| Rate for Payer: Aetna Government |
$12.33
|
| Rate for Payer: Brighton Health Commercial |
$18.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.77
|
| Rate for Payer: Group Health Inc Commercial |
$12.33
|
| Rate for Payer: Group Health Inc Medicare |
$8.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.33
|
|
|
DRAIN, WOUND, HEM, 19FR, 1/4
|
Facility
|
OP
|
$42.98
|
|
| Hospital Charge Code |
64903099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.49
|
| Rate for Payer: Aetna Government |
$21.49
|
| Rate for Payer: Brighton Health Commercial |
$32.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.23
|
| Rate for Payer: Group Health Inc Commercial |
$21.49
|
| Rate for Payer: Group Health Inc Medicare |
$15.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.49
|
|
|
DRAIN WOUND JACK PRAT 10MM FLT
|
Facility
|
OP
|
$99.80
|
|
| Hospital Charge Code |
40202187
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$79.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.90
|
| Rate for Payer: Aetna Government |
$49.90
|
| Rate for Payer: Brighton Health Commercial |
$74.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.86
|
| Rate for Payer: Group Health Inc Commercial |
$49.90
|
| Rate for Payer: Group Health Inc Medicare |
$34.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.90
|
|
|
DRAIN WOUND JACK PRAT 7MM FLT
|
Facility
|
OP
|
$82.32
|
|
| Hospital Charge Code |
64903069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$65.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.16
|
| Rate for Payer: Aetna Government |
$41.16
|
| Rate for Payer: Brighton Health Commercial |
$61.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.98
|
| Rate for Payer: Group Health Inc Commercial |
$41.16
|
| Rate for Payer: Group Health Inc Medicare |
$28.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.16
|
|
|
DRAIN WOUND JACK PRAT 7MM FLT
|
Facility
|
OP
|
$99.80
|
|
| Hospital Charge Code |
40202188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.93 |
| Max. Negotiated Rate |
$79.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.90
|
| Rate for Payer: Aetna Government |
$49.90
|
| Rate for Payer: Brighton Health Commercial |
$74.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.86
|
| Rate for Payer: Group Health Inc Commercial |
$49.90
|
| Rate for Payer: Group Health Inc Medicare |
$34.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.90
|
|
|
DRAIN WOUND JACK PRAT RD 15FR
|
Facility
|
OP
|
$14.65
|
|
| Hospital Charge Code |
64903074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$11.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.32
|
| Rate for Payer: Aetna Government |
$7.32
|
| Rate for Payer: Brighton Health Commercial |
$10.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.96
|
| Rate for Payer: Group Health Inc Commercial |
$7.32
|
| Rate for Payer: Group Health Inc Medicare |
$5.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.32
|
|
|
DRAIN WOUND JAC PRAT 10MM FLT
|
Facility
|
OP
|
$82.32
|
|
| Hospital Charge Code |
64903071
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.81 |
| Max. Negotiated Rate |
$65.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.16
|
| Rate for Payer: Aetna Government |
$41.16
|
| Rate for Payer: Brighton Health Commercial |
$61.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.98
|
| Rate for Payer: Group Health Inc Commercial |
$41.16
|
| Rate for Payer: Group Health Inc Medicare |
$28.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.16
|
|
