|
INSERT TIBI SZ CD/3-5 18MM
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,462.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,337.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,550.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,125.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,443.75
|
| Rate for Payer: EmblemHealth Commercial |
$2,125.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,462.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,125.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,487.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,762.50
|
|
|
INSERT TIBI SZ CD/3-5 18MM
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.00 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
|
|
INSERT TIB RIGHT 14MM CR3-7
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,462.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,337.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,550.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,125.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,443.75
|
| Rate for Payer: EmblemHealth Commercial |
$2,125.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,462.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,125.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,487.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,762.50
|
|
|
INSERT TIB RIGHT 14MM CR3-7
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.00 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
|
|
INSERT TIB X3 TRI
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,800.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,500.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,150.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,500.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,050.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.00
|
|
|
INSERT TIB X3 TRI
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907214
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
|
|
INSERT TIB X3 TS 5533
|
Facility
|
OP
|
$8,643.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$9,075.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,754.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$5,186.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,321.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,970.16
|
| Rate for Payer: EmblemHealth Commercial |
$4,321.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,075.94
|
| Rate for Payer: Group Health Inc Commercial |
$4,321.88
|
| Rate for Payer: Group Health Inc Medicare |
$3,025.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,321.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,321.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,618.44
|
|
|
INSERT TIB X3 TS 5533
|
Facility
|
IP
|
$8,643.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,321.88 |
| Max. Negotiated Rate |
$4,321.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,321.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,321.88
|
|
|
INSERT TISSUE EXPANDERS
|
Facility
|
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 11960
|
| Hospital Charge Code |
40019442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,763.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,904.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,904.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,904.17
|
| Rate for Payer: Brighton Health Commercial |
$6,763.11
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Humana Medicare |
$4,231.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
INSERT TISSUE EXPANDERS
|
Facility
|
IP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 11960
|
| Hospital Charge Code |
40019442
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,148.81
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
40034150
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
INSERT TUNNELED CV CATH
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36561
|
| Hospital Charge Code |
40034150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
INSERT TUNNELED TWO CV CATH
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36565
|
| Hospital Charge Code |
40039651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
INSERT TUNNELED TWO CV CATH
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36565
|
| Hospital Charge Code |
40039651
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
INSERT URINARY CATHETER
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
30300028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
INSERT URINARY CATHETER
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
40000043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
INSERT URINARY CATHETER
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
30304069
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
INSERT URINARY CATHETER
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
30103233
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
INSERT URINARY CATHETER
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
30300028
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
INSERT URINARY CATHETER
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
30103233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
INSERT URINARY CATHETER
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
30306678
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
INSERT URINARY CATHETER
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
40000043
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
INSERT URINARY CATHETER
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 51701
|
| Hospital Charge Code |
30304069
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
INSERT URINARY CATHETER
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
30306678
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
INSERT VENA CAVA FILTER
|
Facility
|
OP
|
$1,769.28
|
|
|
Service Code
|
HCPCS 36010
|
| Hospital Charge Code |
40031995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$542.78
|
| Rate for Payer: Aetna Government |
$542.78
|
| Rate for Payer: Brighton Health Commercial |
$1,326.96
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$884.64
|
| Rate for Payer: Group Health Inc Medicare |
$619.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$884.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$884.64
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
