|
MYCOPHENOLATE MOFETIL 250 MG PO CAPS [15113]
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
00904707461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
MYCOPHENOLIC ACID AND METABO
|
Facility
|
IP
|
$199.70
|
|
|
Service Code
|
HCPCS 80180
|
| Hospital Charge Code |
40601239
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$18.05
|
|
|
MYCOPHENOLIC ACID AND METABO
|
Facility
|
OP
|
$199.70
|
|
|
Service Code
|
HCPCS 80180
|
| Hospital Charge Code |
40601239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$159.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.05
|
| Rate for Payer: Aetna Government |
$18.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.64
|
| Rate for Payer: Brighton Health Commercial |
$149.78
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Cash Price |
$18.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$159.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$135.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.05
|
| Rate for Payer: EmblemHealth Commercial |
$18.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.06
|
| Rate for Payer: Group Health Inc Commercial |
$18.05
|
| Rate for Payer: Group Health Inc Medicare |
$18.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.05
|
| Rate for Payer: Healthfirst QHP |
$18.05
|
| Rate for Payer: Humana Medicare |
$18.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.05
|
| Rate for Payer: United Healthcare Commercial |
$22.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.44
|
| Rate for Payer: Wellcare Medicare |
$16.24
|
|
|
MYCOPLASMA_PNEUMONIAE_CULTURE
|
Facility
|
IP
|
$38.48
|
|
|
Service Code
|
HCPCS 87109
|
| Hospital Charge Code |
40619186
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$15.39
|
|
|
MYCOPLASMA_PNEUMONIAE_CULTURE
|
Facility
|
OP
|
$38.48
|
|
|
Service Code
|
HCPCS 87109
|
| Hospital Charge Code |
40619186
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.39
|
| Rate for Payer: Aetna Government |
$15.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.77
|
| Rate for Payer: Brighton Health Commercial |
$28.86
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.39
|
| Rate for Payer: EmblemHealth Commercial |
$15.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.70
|
| Rate for Payer: Group Health Inc Commercial |
$15.39
|
| Rate for Payer: Group Health Inc Medicare |
$15.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.39
|
| Rate for Payer: Healthfirst QHP |
$15.39
|
| Rate for Payer: Humana Medicare |
$15.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.39
|
| Rate for Payer: United Healthcare Commercial |
$19.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.31
|
| Rate for Payer: Wellcare Medicare |
$13.85
|
|
|
MYCOPLASMA PNEUMONIAE, IGM AB
|
Facility
|
IP
|
$33.10
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
40619175
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.24
|
|
|
MYCOPLASMA PNEUMONIAE, IGM AB
|
Facility
|
OP
|
$33.10
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
40619175
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$24.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.24
|
| Rate for Payer: Aetna Government |
$13.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.27
|
| Rate for Payer: Brighton Health Commercial |
$24.82
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.24
|
| Rate for Payer: EmblemHealth Commercial |
$13.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.24
|
| Rate for Payer: Group Health Inc Medicare |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.24
|
| Rate for Payer: Healthfirst QHP |
$13.24
|
| Rate for Payer: Humana Medicare |
$13.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.59
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
MYCOPLASMA PNEUMONIAW, IGG AB
|
Facility
|
IP
|
$33.10
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
40619176
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.24
|
|
|
MYCOPLASMA PNEUMONIAW, IGG AB
|
Facility
|
OP
|
$33.10
|
|
|
Service Code
|
HCPCS 86738
|
| Hospital Charge Code |
40619176
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$24.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.24
|
| Rate for Payer: Aetna Government |
$13.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.27
|
| Rate for Payer: Brighton Health Commercial |
$24.82
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: Cash Price |
$13.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.24
|
| Rate for Payer: EmblemHealth Commercial |
$13.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.24
|
| Rate for Payer: Group Health Inc Medicare |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.24
|
| Rate for Payer: Healthfirst QHP |
$13.24
|
| Rate for Payer: Humana Medicare |
$13.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.59
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
MYELIN BASIC PROTEIN CSF
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
40609744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.20
|
| Rate for Payer: Aetna Government |
$17.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.04
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.20
|
| Rate for Payer: EmblemHealth Commercial |
$17.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.31
|
| Rate for Payer: Group Health Inc Commercial |
$17.20
|
| Rate for Payer: Group Health Inc Medicare |
$17.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.20
|
| Rate for Payer: Healthfirst QHP |
$17.20
|
| Rate for Payer: Humana Medicare |
$17.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.20
|
| Rate for Payer: United Healthcare Commercial |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.76
|
| Rate for Payer: Wellcare Medicare |
$15.48
|
|
|
MYELIN BASIC PROTEIN CSF
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 83873
|
| Hospital Charge Code |
40609744
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$17.20
|
|
|
MYELOGRAPHY - CERVICAL
|
Facility
|
OP
|
$2,062.03
|
|
|
Service Code
|
HCPCS 72240 TC
|
| Hospital Charge Code |
41542212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$648.14 |
| Max. Negotiated Rate |
$1,134.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,134.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$925.92
|
| Rate for Payer: Aetna Government |
$925.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$648.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$648.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$648.14
|
| Rate for Payer: Brighton Health Commercial |
$925.92
|
| Rate for Payer: Cash Price |
$925.92
|
| Rate for Payer: Cash Price |
$925.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$925.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$998.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$845.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$925.92
|
| Rate for Payer: EmblemHealth Commercial |
$648.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$824.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$925.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$824.07
|
| Rate for Payer: Group Health Inc Commercial |
$833.33
|
| Rate for Payer: Group Health Inc Medicare |
$833.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$925.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$833.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$925.92
|
| Rate for Payer: Healthfirst QHP |
$925.92
|
| Rate for Payer: Humana Medicare |
$944.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$925.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$925.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$925.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$740.74
|
| Rate for Payer: Wellcare Medicare |
$879.62
|
|
|
MYELOGRAPHY - CERVICAL
|
Facility
|
IP
|
$2,062.03
|
|
|
Service Code
|
HCPCS 72240 TC
|
| Hospital Charge Code |
41542212
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$925.92
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$54,259.37
|
|
|
Service Code
|
MSDRG 827
|
| Min. Negotiated Rate |
$18,349.53 |
| Max. Negotiated Rate |
$54,259.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34,167.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39,461.36
|
| Rate for Payer: Aetna Government |
$39,461.36
|
| Rate for Payer: Brighton Health Commercial |
$33,599.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40,250.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40,015.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33,022.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$37,488.29
|
| Rate for Payer: EmblemHealth Commercial |
$19,870.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$39,461.36
|
| Rate for Payer: Group Health Inc Commercial |
$39,461.36
|
| Rate for Payer: Group Health Inc Medicare |
$39,461.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39,461.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,349.53
|
| Rate for Payer: Humana Medicare |
$54,259.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39,461.36
|
| Rate for Payer: United Healthcare Commercial |
$46,082.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39,461.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39,461.36
|
| Rate for Payer: Wellcare Medicare |
$37,488.29
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$98,315.17
|
|
|
Service Code
|
MSDRG 826
|
| Min. Negotiated Rate |
$33,248.40 |
| Max. Negotiated Rate |
$98,315.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64,712.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$71,501.94
|
| Rate for Payer: Aetna Government |
$71,501.94
|
| Rate for Payer: Brighton Health Commercial |
$63,637.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72,931.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79,915.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65,949.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$67,926.84
|
| Rate for Payer: EmblemHealth Commercial |
$37,634.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$71,501.94
|
| Rate for Payer: Group Health Inc Commercial |
$71,501.94
|
| Rate for Payer: Group Health Inc Medicare |
$71,501.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71,501.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33,248.40
|
| Rate for Payer: Humana Medicare |
$98,315.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71,501.94
|
| Rate for Payer: United Healthcare Commercial |
$92,031.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71,501.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71,501.94
|
| Rate for Payer: Wellcare Medicare |
$67,926.84
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$41,354.36
|
|
|
Service Code
|
MSDRG 828
|
| Min. Negotiated Rate |
$13,985.29 |
| Max. Negotiated Rate |
$41,354.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,187.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,075.90
|
| Rate for Payer: Aetna Government |
$30,075.90
|
| Rate for Payer: Brighton Health Commercial |
$23,785.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,677.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,328.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,377.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,572.10
|
| Rate for Payer: EmblemHealth Commercial |
$14,066.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,075.90
|
| Rate for Payer: Group Health Inc Commercial |
$30,075.90
|
| Rate for Payer: Group Health Inc Medicare |
$30,075.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,075.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,985.29
|
| Rate for Payer: Humana Medicare |
$41,354.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,075.90
|
| Rate for Payer: United Healthcare Commercial |
$32,622.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,075.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,075.90
|
| Rate for Payer: Wellcare Medicare |
$28,572.10
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$70,211.36
|
|
|
Service Code
|
MSDRG 829
|
| Min. Negotiated Rate |
$23,744.21 |
| Max. Negotiated Rate |
$70,211.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46,502.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51,062.81
|
| Rate for Payer: Aetna Government |
$51,062.81
|
| Rate for Payer: Brighton Health Commercial |
$45,730.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52,084.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54,462.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44,945.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$48,509.67
|
| Rate for Payer: EmblemHealth Commercial |
$27,043.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$51,062.81
|
| Rate for Payer: Group Health Inc Commercial |
$51,062.81
|
| Rate for Payer: Group Health Inc Medicare |
$51,062.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51,062.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,744.21
|
| Rate for Payer: Humana Medicare |
$70,211.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51,062.81
|
| Rate for Payer: United Healthcare Commercial |
$62,719.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51,062.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51,062.81
|
| Rate for Payer: Wellcare Medicare |
$48,509.67
|
|
|
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$40,225.56
|
|
|
Service Code
|
MSDRG 830
|
| Min. Negotiated Rate |
$13,558.80 |
| Max. Negotiated Rate |
$40,225.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,314.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,254.95
|
| Rate for Payer: Aetna Government |
$29,254.95
|
| Rate for Payer: Brighton Health Commercial |
$22,927.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,840.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,305.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,533.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,792.20
|
| Rate for Payer: EmblemHealth Commercial |
$13,558.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,254.95
|
| Rate for Payer: Group Health Inc Commercial |
$29,254.95
|
| Rate for Payer: Group Health Inc Medicare |
$29,254.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,254.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,603.55
|
| Rate for Payer: Humana Medicare |
$40,225.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,254.95
|
| Rate for Payer: United Healthcare Commercial |
$31,445.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,254.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,254.95
|
| Rate for Payer: Wellcare Medicare |
$27,792.20
|
|
|
MYNX VASC CL DEVICE 5F
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
40008269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$253.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.00
|
| Rate for Payer: Aetna Government |
$230.00
|
| Rate for Payer: Brighton Health Commercial |
$345.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$368.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$312.80
|
| Rate for Payer: Group Health Inc Commercial |
$230.00
|
| Rate for Payer: Group Health Inc Medicare |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.00
|
|
|
MYNX VAS.CLOSURE DEVICE 6FR/7FR
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
40206278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.00
|
|
|
MYNX VAS.CLOSURE DEVICE 6FR/7FR
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
40206278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$253.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.50
|
| Rate for Payer: Aetna Government |
$73.50
|
| Rate for Payer: Brighton Health Commercial |
$276.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$230.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$264.50
|
| Rate for Payer: EmblemHealth Commercial |
$230.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$483.00
|
| Rate for Payer: Group Health Inc Commercial |
$230.00
|
| Rate for Payer: Group Health Inc Medicare |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$299.00
|
|
|
MYOGLOBIN, SERUM
|
Facility
|
OP
|
$32.30
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
40609100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$24.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.92
|
| Rate for Payer: Aetna Government |
$12.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.04
|
| Rate for Payer: Brighton Health Commercial |
$24.22
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.92
|
| Rate for Payer: EmblemHealth Commercial |
$12.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.50
|
| Rate for Payer: Group Health Inc Commercial |
$12.92
|
| Rate for Payer: Group Health Inc Medicare |
$12.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.92
|
| Rate for Payer: Healthfirst QHP |
$12.92
|
| Rate for Payer: Humana Medicare |
$13.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.92
|
| Rate for Payer: United Healthcare Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.34
|
| Rate for Payer: Wellcare Medicare |
$11.63
|
|
|
MYOGLOBIN, SERUM
|
Facility
|
IP
|
$32.30
|
|
|
Service Code
|
HCPCS 83874
|
| Hospital Charge Code |
40609100
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.92
|
|
|
MYOMECTOMY - ABDOMINAL APPROACH
|
Facility
|
OP
|
$2,912.28
|
|
|
Service Code
|
HCPCS 58140
|
| Hospital Charge Code |
40052270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,019.30 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,601.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,147.09
|
| Rate for Payer: Aetna Government |
$1,147.09
|
| Rate for Payer: Brighton Health Commercial |
$2,184.21
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,456.14
|
| Rate for Payer: Group Health Inc Medicare |
$1,019.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,456.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,456.14
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
MYOMECTOMY - VAGINAL APPROACH
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58145
|
| Hospital Charge Code |
40059988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
