|
FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL [180659]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 00338954006
|
| Hospital Charge Code |
00338954006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
FATHOM14 300X10CM
|
Facility
|
OP
|
$850.00
|
|
| Hospital Charge Code |
64904921
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$467.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$425.00
|
| Rate for Payer: Aetna Government |
$425.00
|
| Rate for Payer: Brighton Health Commercial |
$637.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$680.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$578.00
|
| Rate for Payer: Group Health Inc Commercial |
$425.00
|
| Rate for Payer: Group Health Inc Medicare |
$297.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$425.00
|
|
|
FECAL ANALYSIS
|
Facility
|
OP
|
$166.88
|
|
|
Service Code
|
HCPCS 84999
|
| Hospital Charge Code |
40609134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$125.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.44
|
| Rate for Payer: Aetna Government |
$83.44
|
| Rate for Payer: Brighton Health Commercial |
$125.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.31
|
| Rate for Payer: Group Health Inc Commercial |
$83.44
|
| Rate for Payer: Group Health Inc Medicare |
$58.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.44
|
|
|
FECAL FAT, QUALITATIVE
|
Facility
|
OP
|
$12.75
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
40609072
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.10
|
| Rate for Payer: Aetna Government |
$5.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.57
|
| Rate for Payer: Brighton Health Commercial |
$9.56
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.10
|
| Rate for Payer: EmblemHealth Commercial |
$5.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.54
|
| Rate for Payer: Group Health Inc Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Medicare |
$5.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.10
|
| Rate for Payer: Healthfirst QHP |
$5.10
|
| Rate for Payer: Humana Medicare |
$5.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.10
|
| Rate for Payer: United Healthcare Commercial |
$6.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.08
|
| Rate for Payer: Wellcare Medicare |
$4.59
|
|
|
FECAL FAT, QUALITATIVE
|
Facility
|
IP
|
$12.75
|
|
|
Service Code
|
HCPCS 82705
|
| Hospital Charge Code |
40609072
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.10
|
|
|
FECAL FAT QUANTITATIVE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
40608129
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.80
|
| Rate for Payer: Aetna Government |
$16.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.76
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.80
|
| Rate for Payer: EmblemHealth Commercial |
$16.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.95
|
| Rate for Payer: Group Health Inc Commercial |
$16.80
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.80
|
| Rate for Payer: Healthfirst QHP |
$16.80
|
| Rate for Payer: Humana Medicare |
$17.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.44
|
| Rate for Payer: Wellcare Medicare |
$15.12
|
|
|
FECAL FAT QUANTITATIVE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
40608129
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$16.80
|
|
|
FECAL FAT, QUANTITATIVE
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
40609822
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$16.80
|
|
|
FECAL FAT, QUANTITATIVE
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 82710
|
| Hospital Charge Code |
40609822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.80
|
| Rate for Payer: Aetna Government |
$16.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.76
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.80
|
| Rate for Payer: EmblemHealth Commercial |
$16.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.95
|
| Rate for Payer: Group Health Inc Commercial |
$16.80
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.80
|
| Rate for Payer: Healthfirst QHP |
$16.80
|
| Rate for Payer: Humana Medicare |
$17.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.44
|
| Rate for Payer: Wellcare Medicare |
$15.12
|
|
|
Fecal Pouch
|
Facility
|
OP
|
$29.06
|
|
| Hospital Charge Code |
40201750
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.53
|
| Rate for Payer: Aetna Government |
$14.53
|
| Rate for Payer: Brighton Health Commercial |
$21.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.76
|
| Rate for Payer: Group Health Inc Commercial |
$14.53
|
| Rate for Payer: Group Health Inc Medicare |
$10.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.53
|
|
|
FECES CULTURE AEROBIC BACT
|
Facility
|
OP
|
$23.60
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
40614311
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.44
|
| Rate for Payer: Aetna Government |
$9.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.61
|
| Rate for Payer: Brighton Health Commercial |
$17.70
|
| Rate for Payer: Cash Price |
$9.44
|
| Rate for Payer: Cash Price |
$9.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.44
|
| Rate for Payer: EmblemHealth Commercial |
$9.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.40
|
| Rate for Payer: Group Health Inc Commercial |
$9.44
|
| Rate for Payer: Group Health Inc Medicare |
$9.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.44
|
| Rate for Payer: Healthfirst QHP |
$9.44
|
| Rate for Payer: Humana Medicare |
$9.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.44
|
| Rate for Payer: United Healthcare Commercial |
$11.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.55
|
| Rate for Payer: Wellcare Medicare |
$8.50
|
|
|
FECES CULTURE AEROBIC BACT
|
Facility
|
IP
|
$23.60
|
|
|
Service Code
|
HCPCS 87045
|
| Hospital Charge Code |
40614311
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$9.44
|
|
|
FEEDING AID
|
Facility
|
OP
|
$1,087.50
|
|
|
Service Code
|
HCPCS D5951
|
| Hospital Charge Code |
42301325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$598.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$315.16
|
| Rate for Payer: Aetna Government |
$315.16
|
| Rate for Payer: Brighton Health Commercial |
$815.62
|
| 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 |
$543.75
|
| Rate for Payer: Group Health Inc Medicare |
$380.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$543.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$543.75
|
|
|
FEEDING GASTORSTOMY LAP
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
40010930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$10,980.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,670.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,670.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,670.77
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Humana Medicare |
$6,805.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
FEEDING GASTORSTOMY LAP
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 43653
|
| Hospital Charge Code |
40010930
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
|
FEEDING JEJUNOSTOMY
|
Facility
|
OP
|
$407.65
|
|
|
Service Code
|
HCPCS 44015
|
| Hospital Charge Code |
40019815
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.68 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.87
|
| Rate for Payer: Aetna Government |
$169.87
|
| Rate for Payer: Brighton Health Commercial |
$305.74
|
| 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: Group Health Inc Commercial |
$203.82
|
| Rate for Payer: Group Health Inc Medicare |
$142.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.82
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
FEEDING TRAY
|
Facility
|
OP
|
$18.78
|
|
| Hospital Charge Code |
40201810
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.39
|
| Rate for Payer: Aetna Government |
$9.39
|
| Rate for Payer: Brighton Health Commercial |
$14.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.77
|
| Rate for Payer: Group Health Inc Commercial |
$9.39
|
| Rate for Payer: Group Health Inc Medicare |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.39
|
|
|
FEEDING TUBE
|
Facility
|
OP
|
$2.28
|
|
| Hospital Charge Code |
40201811
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.14
|
| Rate for Payer: Aetna Government |
$1.14
|
| Rate for Payer: Brighton Health Commercial |
$1.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.14
|
|
|
FEEDING TUBE KIT
|
Facility
|
OP
|
$345.00
|
|
| Hospital Charge Code |
64903580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$189.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.50
|
| Rate for Payer: Aetna Government |
$172.50
|
| Rate for Payer: Brighton Health Commercial |
$258.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$276.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.60
|
| Rate for Payer: Group Health Inc Commercial |
$172.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.50
|
|
|
FEES BY VIDEO RECORDING
|
Facility
|
OP
|
$198.45
|
|
|
Service Code
|
HCPCS 92612
|
| Hospital Charge Code |
41905000
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$58.95
|
| Rate for Payer: Aetna Government |
$58.95
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$99.22
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.22
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
FEEST
|
Facility
|
OP
|
$289.38
|
|
|
Service Code
|
HCPCS 92616
|
| Hospital Charge Code |
41905009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$159.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.55
|
| Rate for Payer: Aetna Government |
$87.55
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$144.69
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.69
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
FEES- VIDEO WITHOUT SWALLOW EVAL
|
Facility
|
OP
|
$194.73
|
|
|
Service Code
|
HCPCS 92614
|
| Hospital Charge Code |
41905001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$58.63
|
| Rate for Payer: Aetna Government |
$58.63
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$97.36
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.36
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
FE FUMARATE-B12-VIT C-FA-IFC PO CAPS [28030]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 51991063501
|
| Hospital Charge Code |
51991063501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.29
|
|
|
FE FUMARATE-B12-VIT C-FA-IFC PO CAPS [28030]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 63044063510
|
| Hospital Charge Code |
63044063510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
FELT,ADHESIVE,1/4
|
Facility
|
OP
|
$93.52
|
|
| Hospital Charge Code |
64903350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.76
|
| Rate for Payer: Aetna Government |
$46.76
|
| Rate for Payer: Brighton Health Commercial |
$70.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.59
|
| Rate for Payer: Group Health Inc Commercial |
$46.76
|
| Rate for Payer: Group Health Inc Medicare |
$32.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.76
|
|
