NEUMYCIN/POLYMYX/DEX OPHTH OINT
|
Facility
|
OP
|
$3.00
|
|
Hospital Charge Code |
41645758
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
Rate for Payer: Aetna Government |
$1.50
|
Rate for Payer: Brighton Health Commercial |
$2.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
Rate for Payer: Group Health Inc Commercial |
$1.50
|
Rate for Payer: Group Health Inc Medicare |
$1.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
NEURO BEHAVIORAL STATUS EXAM
|
Facility
|
IP
|
$766.58
|
|
Service Code
|
HCPCS 96116
|
Hospital Charge Code |
30400096
|
Hospital Revenue Code
|
918
|
Rate for Payer: Cash Price |
$362.98
|
|
NEURO BEHAVIORAL STATUS EXAM
|
Facility
|
OP
|
$766.58
|
|
Service Code
|
HCPCS 96116
|
Hospital Charge Code |
30400096
|
Hospital Revenue Code
|
918
|
Min. Negotiated Rate |
$261.16 |
Max. Negotiated Rate |
$26,116.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
Rate for Payer: Aetna Government |
$362.98
|
Rate for Payer: Affinity Essential Plan 1&2 |
$587.61
|
Rate for Payer: Affinity Essential Plan 3&4 |
$587.61
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$261.16
|
Rate for Payer: Amida Care Medicaid |
$261.16
|
Rate for Payer: Brighton Health Commercial |
$574.94
|
Rate for Payer: Carelon Behavioral Health HARP/QHP |
$263.54
|
Rate for Payer: Cash Price |
$362.98
|
Rate for Payer: Cash Price |
$362.98
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
Rate for Payer: EmblemHealth Commercial |
$362.98
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26,116.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$261.16
|
Rate for Payer: Fidelis Essential Plan QHP |
$261.16
|
Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
Rate for Payer: Fidelis Qualified Health Plan |
$274.22
|
Rate for Payer: Group Health Inc Commercial |
$362.98
|
Rate for Payer: Group Health Inc Medicare |
$362.98
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.16
|
Rate for Payer: Healthfirst Essential Plan |
$587.61
|
Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
Rate for Payer: Healthfirst QHP |
$261.16
|
Rate for Payer: Humana Medicare |
$370.24
|
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.54
|
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$592.96
|
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$592.96
|
Rate for Payer: Optum Medicaid |
$263.54
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$261.16
|
Rate for Payer: SOMOS Essential |
$587.61
|
Rate for Payer: United Healthcare Commercial |
$383.29
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$587.61
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$287.28
|
Rate for Payer: United Healthcare Medicaid |
$261.16
|
Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
Rate for Payer: Wellcare Medicare |
$344.83
|
|
NEUROBEHAVIORAL STATUS EXAM
|
Facility
|
IP
|
$766.58
|
|
Service Code
|
HCPCS 96116
|
Hospital Charge Code |
30303123
|
Hospital Revenue Code
|
918
|
Rate for Payer: Cash Price |
$362.98
|
|
NEUROBEHAVIORAL STATUS EXAM
|
Facility
|
OP
|
$766.58
|
|
Service Code
|
HCPCS 96116
|
Hospital Charge Code |
30303123
|
Hospital Revenue Code
|
918
|
Min. Negotiated Rate |
$261.16 |
Max. Negotiated Rate |
$26,116.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
Rate for Payer: Aetna Government |
$362.98
|
Rate for Payer: Affinity Essential Plan 1&2 |
$587.61
|
Rate for Payer: Affinity Essential Plan 3&4 |
$587.61
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$261.16
|
Rate for Payer: Amida Care Medicaid |
$261.16
|
Rate for Payer: Brighton Health Commercial |
$574.94
|
Rate for Payer: Carelon Behavioral Health HARP/QHP |
$263.54
|
Rate for Payer: Cash Price |
$362.98
|
Rate for Payer: Cash Price |
$362.98
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
Rate for Payer: EmblemHealth Commercial |
$362.98
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26,116.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$261.16
|
Rate for Payer: Fidelis Essential Plan QHP |
$261.16
|
Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
Rate for Payer: Fidelis Qualified Health Plan |
$274.22
|
Rate for Payer: Group Health Inc Commercial |
$362.98
|
Rate for Payer: Group Health Inc Medicare |
$362.98
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.16
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.16
|
Rate for Payer: Healthfirst Essential Plan |
$587.61
|
Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
Rate for Payer: Healthfirst QHP |
$261.16
|
Rate for Payer: Humana Medicare |
$370.24
|
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.54
|
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$592.96
|
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$592.96
|
Rate for Payer: Optum Medicaid |
$263.54
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$261.16
|
Rate for Payer: SOMOS Essential |
$587.61
|
Rate for Payer: United Healthcare Commercial |
$383.29
|
Rate for Payer: United Healthcare Essential Plan 1&2 |
$587.61
|
Rate for Payer: United Healthcare Essential Plan 3&4 |
$287.28
|
Rate for Payer: United Healthcare Medicaid |
$261.16
|
Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
Rate for Payer: Wellcare Medicare |
$344.83
|
|
NEUROFILAMENT
|
Facility
|
OP
|
$517.50
|
|
Hospital Charge Code |
64902738
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$181.12 |
Max. Negotiated Rate |
$414.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$284.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$258.75
|
Rate for Payer: Aetna Government |
$258.75
|
Rate for Payer: Brighton Health Commercial |
$388.12
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$414.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$351.90
|
Rate for Payer: Group Health Inc Commercial |
$258.75
|
Rate for Payer: Group Health Inc Medicare |
$181.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$258.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$258.75
|
|
NEUROFLEX
|
Facility
|
IP
|
$3,845.55
|
|
Service Code
|
HCPCS C9361
|
Hospital Charge Code |
64904218
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,922.78 |
Max. Negotiated Rate |
$1,922.78 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,922.78
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,922.78
|
|
NEUROFLEX
|
Facility
|
OP
|
$3,845.55
|
|
Service Code
|
HCPCS C9361
|
Hospital Charge Code |
64904218
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$143.89 |
Max. Negotiated Rate |
$4,037.83 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,115.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$143.89
|
Rate for Payer: Aetna Government |
$143.89
|
Rate for Payer: Brighton Health Commercial |
$2,307.33
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,922.78
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,211.19
|
Rate for Payer: EmblemHealth Commercial |
$1,922.78
|
Rate for Payer: Fidelis Medicare Advantage |
$4,037.83
|
Rate for Payer: Group Health Inc Commercial |
$1,922.78
|
Rate for Payer: Group Health Inc Medicare |
$1,345.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,922.78
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,922.78
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,499.61
|
|
NEUROFLEX 2MM
|
Facility
|
IP
|
$3,845.55
|
|
Service Code
|
HCPCS C9361
|
Hospital Charge Code |
64905431
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,922.78 |
Max. Negotiated Rate |
$1,922.78 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,922.78
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,922.78
|
|
NEUROFLEX 2MM
|
Facility
|
OP
|
$3,845.55
|
|
Service Code
|
HCPCS C9361
|
Hospital Charge Code |
64905431
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$143.89 |
Max. Negotiated Rate |
$4,037.83 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,115.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$143.89
|
Rate for Payer: Aetna Government |
$143.89
|
Rate for Payer: Brighton Health Commercial |
$2,307.33
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,922.78
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,211.19
|
Rate for Payer: EmblemHealth Commercial |
$1,922.78
|
Rate for Payer: Fidelis Medicare Advantage |
$4,037.83
|
Rate for Payer: Group Health Inc Commercial |
$1,922.78
|
Rate for Payer: Group Health Inc Medicare |
$1,345.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,922.78
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,922.78
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,499.61
|
|
NEUROFLEX 6MM
|
Facility
|
OP
|
$3,845.55
|
|
Service Code
|
HCPCS C9361
|
Hospital Charge Code |
64905429
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$143.89 |
Max. Negotiated Rate |
$4,037.83 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,115.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$143.89
|
Rate for Payer: Aetna Government |
$143.89
|
Rate for Payer: Brighton Health Commercial |
$2,307.33
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,922.78
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,211.19
|
Rate for Payer: EmblemHealth Commercial |
$1,922.78
|
Rate for Payer: Fidelis Medicare Advantage |
$4,037.83
|
Rate for Payer: Group Health Inc Commercial |
$1,922.78
|
Rate for Payer: Group Health Inc Medicare |
$1,345.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,922.78
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,922.78
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,499.61
|
|
NEUROFLEX 6MM
|
Facility
|
IP
|
$3,845.55
|
|
Service Code
|
HCPCS C9361
|
Hospital Charge Code |
64905429
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,922.78 |
Max. Negotiated Rate |
$1,922.78 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,922.78
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,922.78
|
|
NEUROFLEX TYPE 1 STRY CNCF
|
Facility
|
OP
|
$3,499.45
|
|
Hospital Charge Code |
64907046
|
Hospital Revenue Code
|
279
|
Min. Negotiated Rate |
$1,224.81 |
Max. Negotiated Rate |
$2,799.56 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,924.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,749.72
|
Rate for Payer: Aetna Government |
$1,749.72
|
Rate for Payer: Brighton Health Commercial |
$2,624.59
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,799.56
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,379.63
|
Rate for Payer: Group Health Inc Commercial |
$1,749.72
|
Rate for Payer: Group Health Inc Medicare |
$1,224.81
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,749.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,749.72
|
|
NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$25,406.19
|
|
Service Code
|
MSDRG 123
|
Min. Negotiated Rate |
$6,894.30 |
Max. Negotiated Rate |
$25,406.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,854.98
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,477.23
|
Rate for Payer: Aetna Government |
$18,477.23
|
Rate for Payer: Brighton Health Commercial |
$11,658.00
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,846.77
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,884.28
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,457.90
|
Rate for Payer: Elderplan Medicare Advantage |
$17,553.37
|
Rate for Payer: EmblemHealth Commercial |
$6,894.30
|
Rate for Payer: Fidelis Medicare Advantage |
$18,477.23
|
Rate for Payer: Group Health Inc Commercial |
$18,477.23
|
Rate for Payer: Group Health Inc Medicare |
$18,477.23
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$18,477.23
|
Rate for Payer: Healthfirst Medicare Advantage |
$8,591.91
|
Rate for Payer: Humana Medicare |
$25,406.19
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$18,477.23
|
Rate for Payer: United Healthcare Commercial |
$15,989.15
|
Rate for Payer: United Healthcare Medicare Advantage |
$18,477.23
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,477.23
|
Rate for Payer: Wellcare Medicare |
$17,553.37
|
|
NEUROLYSIS
|
Facility
|
IP
|
$5,207.48
|
|
Service Code
|
HCPCS 64704
|
Hospital Charge Code |
40021765
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$2,232.80
|
|
NEUROLYSIS
|
Facility
|
OP
|
$5,207.48
|
|
Service Code
|
HCPCS 64704
|
Hospital Charge Code |
40021765
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,412.00 |
Max. Negotiated Rate |
$3,905.61 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
Rate for Payer: Aetna Government |
$2,232.80
|
Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
Rate for Payer: Brighton Health Commercial |
$3,905.61
|
Rate for Payer: Cash Price |
$2,232.80
|
Rate for Payer: Cash Price |
$2,232.80
|
Rate for Payer: Cash Price |
$2,232.80
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
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 |
$2,232.80
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
Rate for Payer: Healthfirst QHP |
$2,232.80
|
Rate for Payer: Humana Medicare |
$2,277.46
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
Rate for Payer: United Healthcare Commercial |
$1,468.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
NEURO MUSCULAR MONITORING EQUIP
|
Facility
|
OP
|
$99.23
|
|
Service Code
|
HCPCS 95940
|
Hospital Charge Code |
40209000
|
Hospital Revenue Code
|
920
|
Min. Negotiated Rate |
$28.47 |
Max. Negotiated Rate |
$94.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.58
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.47
|
Rate for Payer: Aetna Government |
$28.47
|
Rate for Payer: Brighton Health Commercial |
$74.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.38
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.48
|
Rate for Payer: Group Health Inc Commercial |
$49.62
|
Rate for Payer: Group Health Inc Medicare |
$34.73
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$49.62
|
Rate for Payer: United Healthcare Commercial |
$94.00
|
|
Neuroplasty and/or transposition; median nerve at carpal tunnel
|
Facility
|
OP
|
$2,915.00
|
|
Service Code
|
CPT 64721
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,468.00 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
Rate for Payer: Aetna Government |
$2,232.80
|
Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
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 |
$2,232.80
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
Rate for Payer: Healthfirst QHP |
$2,232.80
|
Rate for Payer: Humana Medicare |
$2,277.46
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
Rate for Payer: United Healthcare Commercial |
$1,468.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
NEUROSES EXCEPT DEPRESSIVE
|
Facility
|
IP
|
$20,760.54
|
|
Service Code
|
MSDRG 882
|
Min. Negotiated Rate |
$905.00 |
Max. Negotiated Rate |
$20,760.54 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,859.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,353.47
|
Rate for Payer: Aetna Government |
$20,353.47
|
Rate for Payer: Brighton Health Commercial |
$13,619.85
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,760.54
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,220.77
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,386.08
|
Rate for Payer: Elderplan Medicare Advantage |
$19,335.80
|
Rate for Payer: EmblemHealth Commercial |
$905.00
|
Rate for Payer: Fidelis Medicare Advantage |
$20,353.47
|
Rate for Payer: Group Health Inc Commercial |
$20,353.47
|
Rate for Payer: Group Health Inc Medicare |
$20,353.47
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$20,353.47
|
Rate for Payer: Healthfirst Medicare Advantage |
$9,464.36
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$20,353.47
|
Rate for Payer: United Healthcare Commercial |
$18,679.86
|
Rate for Payer: United Healthcare Medicare Advantage |
$20,353.47
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,353.47
|
Rate for Payer: Wellcare Medicare |
$19,335.80
|
|
NEUROSTIMULATOR
|
Facility
|
IP
|
$28,062.50
|
|
Service Code
|
HCPCS C1816
|
Hospital Charge Code |
64902664
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$14,031.25 |
Max. Negotiated Rate |
$14,031.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14,031.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14,031.25
|
|
NEUROSTIMULATOR
|
Facility
|
OP
|
$28,062.50
|
|
Service Code
|
HCPCS C1816
|
Hospital Charge Code |
64902664
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$9,821.88 |
Max. Negotiated Rate |
$29,465.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,434.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,310.20
|
Rate for Payer: Aetna Government |
$15,310.20
|
Rate for Payer: Brighton Health Commercial |
$16,837.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,031.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,135.94
|
Rate for Payer: EmblemHealth Commercial |
$14,031.25
|
Rate for Payer: Fidelis Medicare Advantage |
$29,465.62
|
Rate for Payer: Group Health Inc Commercial |
$14,031.25
|
Rate for Payer: Group Health Inc Medicare |
$9,821.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$14,031.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$14,031.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,240.62
|
|
NEUROSTIMULATOR BAT CHG-TR146
|
Facility
|
OP
|
$85.76
|
|
Hospital Charge Code |
40204300
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$30.02 |
Max. Negotiated Rate |
$68.61 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.88
|
Rate for Payer: Aetna Government |
$42.88
|
Rate for Payer: Brighton Health Commercial |
$64.32
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.61
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.32
|
Rate for Payer: Group Health Inc Commercial |
$42.88
|
Rate for Payer: Group Health Inc Medicare |
$30.02
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$42.88
|
|
NEUROSTIMUL BATRY CHG-MN1604
|
Facility
|
OP
|
$40.40
|
|
Hospital Charge Code |
40204100
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$14.14 |
Max. Negotiated Rate |
$32.32 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.20
|
Rate for Payer: Aetna Government |
$20.20
|
Rate for Payer: Brighton Health Commercial |
$30.30
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.32
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.47
|
Rate for Payer: Group Health Inc Commercial |
$20.20
|
Rate for Payer: Group Health Inc Medicare |
$14.14
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$20.20
|
|
NEUTROPHIL ASSOCIATED ABS
|
Facility
|
IP
|
$37.63
|
|
Service Code
|
HCPCS 86021
|
Hospital Charge Code |
40729895
|
Hospital Revenue Code
|
302
|
Rate for Payer: Cash Price |
$15.05
|
|
NEUTROPHIL ASSOCIATED ABS
|
Facility
|
OP
|
$37.63
|
|
Service Code
|
HCPCS 86021
|
Hospital Charge Code |
40729895
|
Hospital Revenue Code
|
302
|
Min. Negotiated Rate |
$10.54 |
Max. Negotiated Rate |
$28.22 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.05
|
Rate for Payer: Aetna Government |
$15.05
|
Rate for Payer: Affinity Essential Plan 1&2 |
$10.54
|
Rate for Payer: Affinity Essential Plan 3&4 |
$10.54
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.54
|
Rate for Payer: Brighton Health Commercial |
$28.22
|
Rate for Payer: Cash Price |
$15.05
|
Rate for Payer: Cash Price |
$15.05
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.05
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.92
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
Rate for Payer: Elderplan Medicare Advantage |
$15.05
|
Rate for Payer: EmblemHealth Commercial |
$15.05
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$12.79
|
Rate for Payer: Fidelis Essential Plan QHP |
$13.39
|
Rate for Payer: Fidelis Medicare Advantage |
$15.05
|
Rate for Payer: Fidelis Qualified Health Plan |
$13.39
|
Rate for Payer: Group Health Inc Commercial |
$15.05
|
Rate for Payer: Group Health Inc Medicare |
$15.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.82
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$15.05
|
Rate for Payer: Healthfirst Medicare Advantage |
$15.05
|
Rate for Payer: Healthfirst QHP |
$15.05
|
Rate for Payer: Humana Medicare |
$15.35
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$15.05
|
Rate for Payer: United Healthcare Commercial |
$19.07
|
Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.05
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.04
|
Rate for Payer: Wellcare Medicare |
$13.54
|
|