|
INCNTE SPIROMTRY THERAPY
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
HCPCS 94799 TC
|
| Hospital Charge Code |
40301250
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
INCNTE SPIROMTRY THERAPY
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 94799 TC
|
| Hospital Charge Code |
40301250
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$336.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$315.75
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$336.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$286.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
INC OF RECTAL ABSCESS
|
Facility
|
IP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
30307892
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,364.66
|
|
|
INC OF RECTAL ABSCESS
|
Facility
|
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
30307892
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,364.66
|
| Rate for Payer: Aetna Government |
$1,364.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$955.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$955.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$955.26
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,364.66
|
| 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 |
$1,364.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,364.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.55
|
| 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 |
$1,520.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,159.96
|
| Rate for Payer: Healthfirst QHP |
$1,364.66
|
| Rate for Payer: Humana Medicare |
$1,391.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,364.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,364.66
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,364.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,364.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,091.73
|
| Rate for Payer: Wellcare Medicare |
$1,296.43
|
|
|
INCOMPLETE ENDONTIC THERAPY
|
Facility
|
OP
|
$127.58
|
|
|
Service Code
|
HCPCS D3332
|
| Hospital Charge Code |
42303304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$95.68
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
INCOMPLETE ENDONTIC THERAPY
|
Facility
|
IP
|
$127.58
|
|
|
Service Code
|
HCPCS D3332
|
| Hospital Charge Code |
42303304
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
Incontinence Kit
|
Facility
|
OP
|
$52.09
|
|
| Hospital Charge Code |
40202715
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.23 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.04
|
| Rate for Payer: Aetna Government |
$26.04
|
| Rate for Payer: Brighton Health Commercial |
$39.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.42
|
| Rate for Payer: Group Health Inc Commercial |
$26.04
|
| Rate for Payer: Group Health Inc Medicare |
$18.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.04
|
|
|
INDIA-INK PREPARATION
|
Facility
|
OP
|
$14.55
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
40614170
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.82
|
| Rate for Payer: Aetna Government |
$5.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.07
|
| Rate for Payer: Brighton Health Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.82
|
| Rate for Payer: EmblemHealth Commercial |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.18
|
| Rate for Payer: Group Health Inc Commercial |
$5.82
|
| Rate for Payer: Group Health Inc Medicare |
$5.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.82
|
| Rate for Payer: Healthfirst QHP |
$5.82
|
| Rate for Payer: Humana Medicare |
$5.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.82
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.66
|
| Rate for Payer: Wellcare Medicare |
$5.24
|
|
|
INDIA-INK PREPARATION
|
Facility
|
IP
|
$14.55
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
40614170
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$5.82
|
|
|
INDICATOR BIOLOGICAL ATTEST
|
Facility
|
OP
|
$912.00
|
|
| Hospital Charge Code |
40202199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$729.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$501.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$456.00
|
| Rate for Payer: Aetna Government |
$456.00
|
| Rate for Payer: Brighton Health Commercial |
$684.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$729.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$620.16
|
| Rate for Payer: Group Health Inc Commercial |
$456.00
|
| Rate for Payer: Group Health Inc Medicare |
$319.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.00
|
|
|
INDICATOR BIOLOGICAL SELF-CONTND
|
Facility
|
OP
|
$3.26
|
|
| Hospital Charge Code |
64901797
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.63
|
| Rate for Payer: Aetna Government |
$1.63
|
| Rate for Payer: Brighton Health Commercial |
$2.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.22
|
| Rate for Payer: Group Health Inc Commercial |
$1.63
|
| Rate for Payer: Group Health Inc Medicare |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.63
|
|
|
INDICATOR BIOLOGICAL SLFCONTAINED
|
Facility
|
OP
|
$268.00
|
|
| Hospital Charge Code |
40202201
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$214.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.00
|
| Rate for Payer: Aetna Government |
$134.00
|
| Rate for Payer: Brighton Health Commercial |
$201.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$214.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.24
|
| Rate for Payer: Group Health Inc Commercial |
$134.00
|
| Rate for Payer: Group Health Inc Medicare |
$93.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.00
|
|
|
INDICATOR BIOL STERRAD CYCLESURE
|
Facility
|
OP
|
$30.53
|
|
| Hospital Charge Code |
64904473
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.26
|
| Rate for Payer: Aetna Government |
$15.26
|
| Rate for Payer: Brighton Health Commercial |
$22.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.76
|
| Rate for Payer: Group Health Inc Commercial |
$15.26
|
| Rate for Payer: Group Health Inc Medicare |
$10.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.26
|
|
|
INDICATORS, CHEMICAL
|
Facility
|
OP
|
$0.54
|
|
| Hospital Charge Code |
64903822
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
|
|
INDICATOR,STEAM,AT,RAPID,3HR,BRN
|
Facility
|
OP
|
$0.53
|
|
| Hospital Charge Code |
64904413
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
|
|
INDICATOR,STEAM STERILIZER,RAPID
|
Facility
|
OP
|
$0.52
|
|
| Hospital Charge Code |
64904405
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
|
|
INDICATOR STERI WASHER ALL CL
|
Facility
|
OP
|
$6.14
|
|
| Hospital Charge Code |
64905249
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$4.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.07
|
| Rate for Payer: Aetna Government |
$3.07
|
| Rate for Payer: Brighton Health Commercial |
$4.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.18
|
| Rate for Payer: Group Health Inc Commercial |
$3.07
|
| Rate for Payer: Group Health Inc Medicare |
$2.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.07
|
|
|
INDIGO CARMINE 0.8% INJ
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
41650775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$5.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
INDIGO CARMINE 0.8% INJ
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
41640775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$5.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
INDIGO CATH 8 TORQ TIP 85CM 8F
|
Facility
|
IP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
41103925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,990.00 |
| Max. Negotiated Rate |
$2,990.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,990.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,990.00
|
|
|
INDIGO CATH 8 TORQ TIP 85CM 8F
|
Facility
|
OP
|
$5,980.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
41103925
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$6,279.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,289.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$3,588.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,990.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,438.50
|
| Rate for Payer: EmblemHealth Commercial |
$2,990.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,279.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,990.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,093.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,990.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,990.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,887.00
|
|
|
INDIGO CATH STRAIGHT 135CM GUID
|
Facility
|
OP
|
$3,980.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
41103921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$4,179.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,189.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Brighton Health Commercial |
$2,388.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,990.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,288.50
|
| Rate for Payer: EmblemHealth Commercial |
$1,990.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,179.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,990.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,393.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,990.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,990.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,587.00
|
|
|
INDIGO CATH STRAIGHT 135CM GUID
|
Facility
|
IP
|
$3,980.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
41103921
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,990.00 |
| Max. Negotiated Rate |
$1,990.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,990.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,990.00
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML IJ SOLN [10265]
|
Facility
|
OP
|
$45.22
|
|
|
Service Code
|
NDC 00517037505
|
| Hospital Charge Code |
00517037505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$36.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.61
|
| Rate for Payer: Aetna Government |
$22.61
|
| Rate for Payer: Brighton Health Commercial |
$33.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.75
|
| Rate for Payer: Group Health Inc Commercial |
$22.61
|
| Rate for Payer: Group Health Inc Medicare |
$15.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.39
|
|
|
IND IMG HD POS HD ACHE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2191
|
| Hospital Charge Code |
30300319
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| 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: United Healthcare Commercial |
$94.00
|
|
