|
MARX TEMPORARY CONDYLAR
|
Facility
|
OP
|
$1,726.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40201199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,812.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$949.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,035.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$863.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$992.45
|
| Rate for Payer: EmblemHealth Commercial |
$863.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,812.30
|
| Rate for Payer: Group Health Inc Commercial |
$863.00
|
| Rate for Payer: Group Health Inc Medicare |
$604.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$863.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$863.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,121.90
|
|
|
MARYLAND BRIDGE WING
|
Facility
|
OP
|
$362.50
|
|
|
Service Code
|
HCPCS D6545
|
| Hospital Charge Code |
42301525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.26 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.26
|
| Rate for Payer: Aetna Government |
$121.26
|
| Rate for Payer: Brighton Health Commercial |
$271.88
|
| 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 |
$181.25
|
| Rate for Payer: Group Health Inc Medicare |
$126.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.25
|
|
|
MA SAMEDAY DX BILAT
|
Facility
|
OP
|
$502.90
|
|
|
Service Code
|
HCPCS 77066 TC
|
| Hospital Charge Code |
41104000
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$402.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.39
|
| Rate for Payer: Aetna Government |
$95.39
|
| Rate for Payer: Brighton Health Commercial |
$377.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$402.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$341.97
|
| Rate for Payer: Group Health Inc Commercial |
$251.45
|
| Rate for Payer: Group Health Inc Medicare |
$176.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.45
|
| Rate for Payer: United Healthcare Commercial |
$100.57
|
|
|
MA SAMEDAY DX UNILAT
|
Facility
|
OP
|
$399.85
|
|
|
Service Code
|
HCPCS 77065 TC
|
| Hospital Charge Code |
41104003
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$319.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.60
|
| Rate for Payer: Aetna Government |
$74.60
|
| Rate for Payer: Brighton Health Commercial |
$299.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.90
|
| Rate for Payer: Group Health Inc Commercial |
$199.92
|
| Rate for Payer: Group Health Inc Medicare |
$139.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.92
|
| Rate for Payer: United Healthcare Commercial |
$78.82
|
|
|
MASK CPAP EASYLIFE SZ MED
|
Facility
|
OP
|
$122.50
|
|
| Hospital Charge Code |
64902649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.88 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.25
|
| Rate for Payer: Aetna Government |
$61.25
|
| Rate for Payer: Brighton Health Commercial |
$91.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$98.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.30
|
| Rate for Payer: Group Health Inc Commercial |
$61.25
|
| Rate for Payer: Group Health Inc Medicare |
$42.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.25
|
|
|
MASK CPAP EASYLIFE SZ SM
|
Facility
|
OP
|
$122.50
|
|
| Hospital Charge Code |
64902647
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.88 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.25
|
| Rate for Payer: Aetna Government |
$61.25
|
| Rate for Payer: Brighton Health Commercial |
$91.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$98.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.30
|
| Rate for Payer: Group Health Inc Commercial |
$61.25
|
| Rate for Payer: Group Health Inc Medicare |
$42.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.25
|
|
|
MASK CPAP EASYLIFE W HEADGR
|
Facility
|
OP
|
$122.50
|
|
| Hospital Charge Code |
64902650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.88 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.25
|
| Rate for Payer: Aetna Government |
$61.25
|
| Rate for Payer: Brighton Health Commercial |
$91.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$98.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.30
|
| Rate for Payer: Group Health Inc Commercial |
$61.25
|
| Rate for Payer: Group Health Inc Medicare |
$42.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.25
|
|
|
MASK CPAP SMALL
|
Facility
|
OP
|
$33.75
|
|
| Hospital Charge Code |
64902266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.88
|
| Rate for Payer: Aetna Government |
$16.88
|
| Rate for Payer: Brighton Health Commercial |
$25.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.95
|
| Rate for Payer: Group Health Inc Commercial |
$16.88
|
| Rate for Payer: Group Health Inc Medicare |
$11.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.88
|
|
|
MASK FLUIDSHIELD W/WRAPVISOR15310
|
Facility
|
OP
|
$0.78
|
|
| Hospital Charge Code |
40209460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
|
|
MASK LARYNGEAL AIRWY SZ5 CLASSIC
|
Facility
|
OP
|
$133.34
|
|
| Hospital Charge Code |
40200947
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.67 |
| Max. Negotiated Rate |
$106.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.67
|
| Rate for Payer: Aetna Government |
$66.67
|
| Rate for Payer: Brighton Health Commercial |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.67
|
| Rate for Payer: Group Health Inc Commercial |
$66.67
|
| Rate for Payer: Group Health Inc Medicare |
$46.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.67
|
|
|
MASK SURGICAL CONE CLASSIC 3333
|
Facility
|
OP
|
$0.06
|
|
| Hospital Charge Code |
40209480
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
|
|
Mastectomy for gynecomastia
|
Facility
|
OP
|
$4,496.14
|
|
|
Service Code
|
CPT 19300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,496.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,407.98
|
| Rate for Payer: Aetna Government |
$4,407.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,085.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,085.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,085.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,407.98
|
| 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 |
$4,407.98
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,746.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,923.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,407.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,923.10
|
| Rate for Payer: Group Health Inc Commercial |
$4,407.98
|
| Rate for Payer: Group Health Inc Medicare |
$4,407.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,407.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,746.78
|
| Rate for Payer: Healthfirst QHP |
$4,407.98
|
| Rate for Payer: Humana Medicare |
$4,496.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,407.98
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,407.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,407.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,526.38
|
| Rate for Payer: Wellcare Medicare |
$4,187.58
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$43,278.28
|
|
|
Service Code
|
MSDRG 582
|
| Min. Negotiated Rate |
$14,295.40 |
| Max. Negotiated Rate |
$43,278.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,581.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31,475.11
|
| Rate for Payer: Aetna Government |
$31,475.11
|
| Rate for Payer: Brighton Health Commercial |
$24,172.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,104.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30,070.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,815.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,901.35
|
| Rate for Payer: EmblemHealth Commercial |
$14,295.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$31,475.11
|
| Rate for Payer: Group Health Inc Commercial |
$31,475.11
|
| Rate for Payer: Group Health Inc Medicare |
$31,475.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31,475.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,635.93
|
| Rate for Payer: Humana Medicare |
$43,278.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31,475.11
|
| Rate for Payer: United Healthcare Commercial |
$34,629.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,475.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31,475.11
|
| Rate for Payer: Wellcare Medicare |
$29,901.35
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$39,094.84
|
|
|
Service Code
|
MSDRG 583
|
| Min. Negotiated Rate |
$13,050.30 |
| Max. Negotiated Rate |
$39,094.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,440.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,432.61
|
| Rate for Payer: Aetna Government |
$28,432.61
|
| Rate for Payer: Brighton Health Commercial |
$22,067.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,001.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,281.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,688.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,010.98
|
| Rate for Payer: EmblemHealth Commercial |
$13,050.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,432.61
|
| Rate for Payer: Group Health Inc Commercial |
$28,432.61
|
| Rate for Payer: Group Health Inc Medicare |
$28,432.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,432.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,221.16
|
| Rate for Payer: Humana Medicare |
$39,094.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,432.61
|
| Rate for Payer: United Healthcare Commercial |
$30,266.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,432.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,432.61
|
| Rate for Payer: Wellcare Medicare |
$27,010.98
|
|
|
MASTECTOMY MOD RAD LYMPH NODE DIS
|
Facility
|
OP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
40013226
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$11,896.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,541.13
|
| Rate for Payer: Aetna Government |
$7,541.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,278.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,278.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,278.79
|
| Rate for Payer: Brighton Health Commercial |
$11,896.84
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,541.13
|
| 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 |
$7,541.13
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,409.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,711.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,541.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,711.61
|
| Rate for Payer: Group Health Inc Commercial |
$7,541.13
|
| Rate for Payer: Group Health Inc Medicare |
$7,541.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,931.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,541.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,409.96
|
| Rate for Payer: Healthfirst QHP |
$7,541.13
|
| Rate for Payer: Humana Medicare |
$7,691.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,541.13
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,541.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,541.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,032.90
|
| Rate for Payer: Wellcare Medicare |
$7,164.07
|
|
|
MASTECTOMY MOD RAD LYMPH NODE DIS
|
Facility
|
IP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 19307
|
| Hospital Charge Code |
40013226
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,541.13
|
|
|
Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);
|
Facility
|
OP
|
$4,496.14
|
|
|
Service Code
|
CPT 19301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,496.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,407.98
|
| Rate for Payer: Aetna Government |
$4,407.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,085.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,085.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,085.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,407.98
|
| 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 |
$4,407.98
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,746.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,923.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,407.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,923.10
|
| Rate for Payer: Group Health Inc Commercial |
$4,407.98
|
| Rate for Payer: Group Health Inc Medicare |
$4,407.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,407.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,746.78
|
| Rate for Payer: Healthfirst QHP |
$4,407.98
|
| Rate for Payer: Humana Medicare |
$4,496.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,407.98
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,407.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,407.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,526.38
|
| Rate for Payer: Wellcare Medicare |
$4,187.58
|
|
|
Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy
|
Facility
|
OP
|
$7,691.95
|
|
|
Service Code
|
CPT 19302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,691.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,541.13
|
| Rate for Payer: Aetna Government |
$7,541.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,278.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,278.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,278.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,541.13
|
| 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 |
$7,541.13
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,409.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,711.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,541.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,711.61
|
| Rate for Payer: Group Health Inc Commercial |
$7,541.13
|
| Rate for Payer: Group Health Inc Medicare |
$7,541.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,541.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,409.96
|
| Rate for Payer: Healthfirst QHP |
$7,541.13
|
| Rate for Payer: Humana Medicare |
$7,691.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,541.13
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,541.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,541.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,032.90
|
| Rate for Payer: Wellcare Medicare |
$7,164.07
|
|
|
Mastectomy, simple, complete
|
Facility
|
OP
|
$7,691.95
|
|
|
Service Code
|
CPT 19303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,691.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,541.13
|
| Rate for Payer: Aetna Government |
$7,541.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,278.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,278.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,278.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,541.13
|
| 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 |
$7,541.13
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,409.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,711.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,541.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,711.61
|
| Rate for Payer: Group Health Inc Commercial |
$7,541.13
|
| Rate for Payer: Group Health Inc Medicare |
$7,541.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,541.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,409.96
|
| Rate for Payer: Healthfirst QHP |
$7,541.13
|
| Rate for Payer: Humana Medicare |
$7,691.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,541.13
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,541.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,541.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,032.90
|
| Rate for Payer: Wellcare Medicare |
$7,164.07
|
|
|
MASTOPEXY
|
Facility
|
IP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 19316
|
| Hospital Charge Code |
40014309
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,541.13
|
|
|
MASTOPEXY
|
Facility
|
OP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 19316
|
| Hospital Charge Code |
40014309
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$11,896.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,541.13
|
| Rate for Payer: Aetna Government |
$7,541.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,278.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,278.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,278.79
|
| Rate for Payer: Brighton Health Commercial |
$11,896.84
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,541.13
|
| 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 |
$7,541.13
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,409.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,711.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,541.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,711.61
|
| Rate for Payer: Group Health Inc Commercial |
$7,541.13
|
| Rate for Payer: Group Health Inc Medicare |
$7,541.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,931.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,541.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,409.96
|
| Rate for Payer: Healthfirst QHP |
$7,541.13
|
| Rate for Payer: Humana Medicare |
$7,691.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,541.13
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,541.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,541.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,032.90
|
| Rate for Payer: Wellcare Medicare |
$7,164.07
|
|
|
MASTORDECTOMY
|
Facility
|
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 69502
|
| Hospital Charge Code |
40108990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$11,018.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Brighton Health Commercial |
$11,018.29
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
MASTORDECTOMY
|
Facility
|
IP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 69502
|
| Hospital Charge Code |
40108990
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,772.21
|
|
|
MASTORDECTOMY W LABYRINTHECTOMY
|
Facility
|
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 69910
|
| Hospital Charge Code |
40109217
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$11,018.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Brighton Health Commercial |
$11,018.29
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
MASTORDECTOMY W LABYRINTHECTOMY
|
Facility
|
IP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 69910
|
| Hospital Charge Code |
40109217
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,772.21
|
|
