|
FIX PARTIAL DENTURE SECTION
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS D9120
|
| Hospital Charge Code |
42303432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.44
|
| Rate for Payer: Aetna Government |
$31.44
|
| Rate for Payer: Brighton Health Commercial |
$150.00
|
| 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 |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
FLAT BLADE
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
64907164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$187.50
|
| Rate for Payer: Aetna Government |
$187.50
|
| Rate for Payer: Brighton Health Commercial |
$281.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.00
|
| Rate for Payer: Group Health Inc Commercial |
$187.50
|
| Rate for Payer: Group Health Inc Medicare |
$131.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.50
|
|
|
FLATUS BAG
|
Facility
|
OP
|
$6.03
|
|
| Hospital Charge Code |
40207618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$4.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$2.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
|
|
FL BARIUM ENEMA W/AIR
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74280 TC
|
| Hospital Charge Code |
41102102
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
FL BARIUM ENEMA W/AIR
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74280 TC
|
| Hospital Charge Code |
41102102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.73 |
| Max. Negotiated Rate |
$303.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$284.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$240.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
FL BARIUM ENEMA W/O AIR
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74270 TC
|
| Hospital Charge Code |
41102104
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
FL BARIUM ENEMA W/O AIR
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74270 TC
|
| Hospital Charge Code |
41102104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.86 |
| Max. Negotiated Rate |
$303.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
FL BARIUM SWALLOW FOR F.B.
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74210 TC
|
| Hospital Charge Code |
41102498
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
FL BARIUM SWALLOW FOR F.B.
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74210 TC
|
| Hospital Charge Code |
41102498
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.86 |
| Max. Negotiated Rate |
$303.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
FL CHOLECYSTOGRAM
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74290 TC
|
| Hospital Charge Code |
41102108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.86 |
| Max. Negotiated Rate |
$303.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
FL CHOLECYSTOGRAM
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74290 TC
|
| Hospital Charge Code |
41102108
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
FL CHOLECYSTOGRAM DD
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74290 TC
|
| Hospital Charge Code |
41102512
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.86 |
| Max. Negotiated Rate |
$303.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
FL CHOLECYSTOGRAM DD
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74290 TC
|
| Hospital Charge Code |
41102512
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
FLEET ENEMA
|
Facility
|
OP
|
$9.57
|
|
| Hospital Charge Code |
40201815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Brighton Health Commercial |
$7.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
FLEET ENEMA 7-19 GM/118ML RE ENEM [3123]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 70000010801
|
| Hospital Charge Code |
70000010801
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
FLEET ENEMA 7-19 GM/118ML RE ENEM [3123]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 00132020140
|
| Hospital Charge Code |
00132020140
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
FLEET PEDIATRIC 3.5-9.5 GM/59ML RE ENEM [3128]
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 00132020220
|
| Hospital Charge Code |
00132020220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
FL ESOPHAGRAM
|
Facility
|
IP
|
$551.90
|
|
|
Service Code
|
HCPCS 74220 TC
|
| Hospital Charge Code |
41102106
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$212.47
|
|
|
FL ESOPHAGRAM
|
Facility
|
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74220 TC
|
| Hospital Charge Code |
41102106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.86 |
| Max. Negotiated Rate |
$303.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$212.47
|
| Rate for Payer: Aetna Government |
$212.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$148.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$148.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$148.73
|
| Rate for Payer: Brighton Health Commercial |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$173.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$212.47
|
| Rate for Payer: EmblemHealth Commercial |
$148.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.10
|
| Rate for Payer: Group Health Inc Commercial |
$191.22
|
| Rate for Payer: Group Health Inc Medicare |
$191.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.47
|
| Rate for Payer: Healthfirst QHP |
$212.47
|
| Rate for Payer: Humana Medicare |
$216.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$169.98
|
| Rate for Payer: Wellcare Medicare |
$201.85
|
|
|
FLEX 60 ARTICULATING
|
Facility
|
OP
|
$2,534.60
|
|
| Hospital Charge Code |
64905189
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$887.11 |
| Max. Negotiated Rate |
$2,027.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,394.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,267.30
|
| Rate for Payer: Aetna Government |
$1,267.30
|
| Rate for Payer: Brighton Health Commercial |
$1,900.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,027.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,723.53
|
| Rate for Payer: Group Health Inc Commercial |
$1,267.30
|
| Rate for Payer: Group Health Inc Medicare |
$887.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,267.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,267.30
|
|
|
FLEXCHFLO870
|
Facility
|
OP
|
$339.45
|
|
| Hospital Charge Code |
41569813
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Brighton Health Commercial |
$254.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
|
|
FLEX GRAFTON DBM 1.5CM X 1.5CM
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$603.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$316.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$345.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$287.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$330.62
|
| Rate for Payer: EmblemHealth Commercial |
$287.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$603.75
|
| Rate for Payer: Group Health Inc Commercial |
$287.50
|
| Rate for Payer: Group Health Inc Medicare |
$201.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$373.75
|
|
|
FLEX GRAFTON DBM 1.5CM X 1.5CM
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.50 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.50
|
|
|
FLEXICAIRE M4000 M3
|
Facility
|
OP
|
$211.21
|
|
| Hospital Charge Code |
40209118
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$168.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.60
|
| Rate for Payer: Aetna Government |
$105.60
|
| Rate for Payer: Brighton Health Commercial |
$158.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.62
|
| Rate for Payer: Group Health Inc Commercial |
$105.60
|
| Rate for Payer: Group Health Inc Medicare |
$73.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.60
|
|
|
FLEXI CARE BED
|
Facility
|
OP
|
$162.66
|
|
| Hospital Charge Code |
40200922
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.93 |
| Max. Negotiated Rate |
$130.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.33
|
| Rate for Payer: Aetna Government |
$81.33
|
| Rate for Payer: Brighton Health Commercial |
$122.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.61
|
| Rate for Payer: Group Health Inc Commercial |
$81.33
|
| Rate for Payer: Group Health Inc Medicare |
$56.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.33
|
|
