|
ORAL ADMIN OF SUBOXONE 4-1MG
|
Facility
|
OP
|
$82.54
|
|
|
Service Code
|
HCPCS H0033
|
| Hospital Charge Code |
30402551
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$66.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Brighton Health Commercial |
$61.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.13
|
| Rate for Payer: Group Health Inc Commercial |
$41.27
|
| Rate for Payer: Group Health Inc Medicare |
$28.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.27
|
| Rate for Payer: United Healthcare Commercial |
$41.27
|
|
|
ORAL ADMIN OF SUBOXONE 8-2MG
|
Facility
|
OP
|
$82.54
|
|
|
Service Code
|
HCPCS H0033
|
| Hospital Charge Code |
30402552
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$66.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Brighton Health Commercial |
$61.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.13
|
| Rate for Payer: Group Health Inc Commercial |
$41.27
|
| Rate for Payer: Group Health Inc Medicare |
$28.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.27
|
| Rate for Payer: United Healthcare Commercial |
$41.27
|
|
|
ORAL ANTRAL FISTULA CLOSURE
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS D7260
|
| Hospital Charge Code |
42301685
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
ORAL ANTRAL FISTULA CLOSURE
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS D7260
|
| Hospital Charge Code |
42301685
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$375.00
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
ORAL DEVICE/APPLIANCE CUSFAB
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS E0486
|
| Hospital Charge Code |
40203550
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$80,800.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,014.81
|
| Rate for Payer: Aetna Government |
$2,014.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,818.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,818.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$808.00
|
| Rate for Payer: Amida Care Medicaid |
$808.00
|
| Rate for Payer: Brighton Health Commercial |
$900.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$960.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$816.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80,800.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$808.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$808.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$848.40
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$808.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$808.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,818.00
|
| Rate for Payer: Healthfirst QHP |
$808.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$808.00
|
| Rate for Payer: SOMOS Essential |
$808.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,818.00
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$888.80
|
| Rate for Payer: United Healthcare Medicaid |
$808.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$808.00
|
|
|
ORAL EVALUATION PT < 3 YEARS OLD
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS D0145
|
| Hospital Charge Code |
42303415
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.30
|
| Rate for Payer: Aetna Government |
$18.30
|
| Rate for Payer: Brighton Health Commercial |
$56.25
|
| 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 |
$37.50
|
| Rate for Payer: Group Health Inc Medicare |
$26.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.50
|
|
|
ORAL/FACIAL IMAGES
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS D0350
|
| Hospital Charge Code |
42303276
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| 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 |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$105.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$105.08
|
| Rate for Payer: Group Health Inc Medicare |
$105.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.32
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
ORAL/FACIAL IMAGES
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS D0350
|
| Hospital Charge Code |
42303276
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
ORAL HYGIENE INSTRUCTIONS
|
Facility
|
OP
|
$77.96
|
|
|
Service Code
|
HCPCS D1330
|
| Hospital Charge Code |
42300275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.47
|
| Rate for Payer: Aetna Government |
$17.47
|
| Rate for Payer: Brighton Health Commercial |
$58.47
|
| 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 |
$38.98
|
| Rate for Payer: Group Health Inc Medicare |
$27.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.98
|
|
|
ORAL MED, DIRECT OBSERVATION
|
Facility
|
OP
|
$82.54
|
|
|
Service Code
|
HCPCS H0033
|
| Hospital Charge Code |
30400237
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$66.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Brighton Health Commercial |
$61.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.13
|
| Rate for Payer: Group Health Inc Commercial |
$41.27
|
| Rate for Payer: Group Health Inc Medicare |
$28.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.27
|
| Rate for Payer: United Healthcare Commercial |
$41.27
|
|
|
ORAL PREMED
|
Facility
|
OP
|
$106.31
|
|
| Hospital Charge Code |
42302325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.16
|
| Rate for Payer: Aetna Government |
$53.16
|
| Rate for Payer: Brighton Health Commercial |
$79.73
|
| 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 |
$53.16
|
| Rate for Payer: Group Health Inc Medicare |
$37.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.16
|
|
|
ORAL SURGICAL SPLINTING
|
Facility
|
IP
|
$616.78
|
|
|
Service Code
|
HCPCS 21085
|
| Hospital Charge Code |
30102926
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
ORAL SURGICAL SPLINTING
|
Facility
|
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 21085
|
| Hospital Charge Code |
30102926
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$197.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$197.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$197.73
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Humana Medicare |
$288.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
ORANGE DIALYZERS
|
Facility
|
OP
|
$58.12
|
|
| Hospital Charge Code |
42905321
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.06
|
| Rate for Payer: Aetna Government |
$29.06
|
| Rate for Payer: Brighton Health Commercial |
$43.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.52
|
| Rate for Payer: Group Health Inc Commercial |
$29.06
|
| Rate for Payer: Group Health Inc Medicare |
$20.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.06
|
|
|
ORAQUICK HIV-1/2 AB TEST
|
Facility
|
IP
|
$34.28
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
40614124
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.71
|
|
|
ORAQUICK HIV-1/2 AB TEST
|
Facility
|
OP
|
$34.28
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
40614124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$1,559.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.71
|
| Rate for Payer: Aetna Government |
$13.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.59
|
| Rate for Payer: Amida Care Medicaid |
$15.59
|
| Rate for Payer: Brighton Health Commercial |
$25.71
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.71
|
| Rate for Payer: EmblemHealth Commercial |
$13.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,559.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.37
|
| Rate for Payer: Group Health Inc Commercial |
$13.71
|
| Rate for Payer: Group Health Inc Medicare |
$13.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.59
|
| Rate for Payer: Healthfirst Essential Plan |
$35.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.71
|
| Rate for Payer: Healthfirst QHP |
$15.59
|
| Rate for Payer: Humana Medicare |
$13.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.59
|
| Rate for Payer: SOMOS Essential |
$15.59
|
| Rate for Payer: United Healthcare Commercial |
$17.37
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$35.08
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$17.15
|
| Rate for Payer: United Healthcare Medicaid |
$15.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.97
|
| Rate for Payer: Wellcare Medicare |
$12.34
|
|
|
ORASURE TEST
|
Facility
|
OP
|
$22.23
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
40728500
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,010.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$22.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$22.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.10
|
| Rate for Payer: Amida Care Medicaid |
$10.10
|
| Rate for Payer: Brighton Health Commercial |
$16.67
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,010.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.60
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Healthfirst Essential Plan |
$22.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.89
|
| Rate for Payer: Healthfirst QHP |
$10.10
|
| Rate for Payer: Humana Medicare |
$9.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.10
|
| Rate for Payer: SOMOS Essential |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$11.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$22.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$11.11
|
| Rate for Payer: United Healthcare Medicaid |
$10.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.00
|
|
|
ORASURE TEST
|
Facility
|
IP
|
$22.23
|
|
|
Service Code
|
HCPCS 86701
|
| Hospital Charge Code |
40728500
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$8.89
|
|
|
ORA-SWEET PO SYRP [5852]
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 00574030416
|
| Hospital Charge Code |
00574030416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
ORBITAL FLOOR TEMPLATE, LARGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.00
|
|
|
ORBITAL FLOOR TEMPLATE, LARGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$39.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.95
|
| Rate for Payer: EmblemHealth Commercial |
$33.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.30
|
| Rate for Payer: Group Health Inc Commercial |
$33.00
|
| Rate for Payer: Group Health Inc Medicare |
$23.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.90
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$57,884.12
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$19,575.36 |
| Max. Negotiated Rate |
$57,884.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36,970.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42,097.54
|
| Rate for Payer: Aetna Government |
$42,097.54
|
| Rate for Payer: Brighton Health Commercial |
$36,355.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42,939.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43,298.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35,731.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$39,992.66
|
| Rate for Payer: EmblemHealth Commercial |
$21,500.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$42,097.54
|
| Rate for Payer: Group Health Inc Commercial |
$42,097.54
|
| Rate for Payer: Group Health Inc Medicare |
$42,097.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42,097.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,575.36
|
| Rate for Payer: Humana Medicare |
$57,884.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42,097.54
|
| Rate for Payer: United Healthcare Commercial |
$49,862.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42,097.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42,097.54
|
| Rate for Payer: Wellcare Medicare |
$39,992.66
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,563.31
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$10,562.70 |
| Max. Negotiated Rate |
$33,563.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,162.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,409.68
|
| Rate for Payer: Aetna Government |
$24,409.68
|
| Rate for Payer: Brighton Health Commercial |
$17,861.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,897.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,271.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,554.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,189.20
|
| Rate for Payer: EmblemHealth Commercial |
$10,562.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,409.68
|
| Rate for Payer: Group Health Inc Commercial |
$24,409.68
|
| Rate for Payer: Group Health Inc Medicare |
$24,409.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,409.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,350.50
|
| Rate for Payer: Humana Medicare |
$33,563.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,409.68
|
| Rate for Payer: United Healthcare Commercial |
$24,496.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,409.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,409.68
|
| Rate for Payer: Wellcare Medicare |
$23,189.20
|
|
|
ORBITAL PROSTHESIS
|
Facility
|
OP
|
$2,392.50
|
|
|
Service Code
|
HCPCS D5915
|
| Hospital Charge Code |
42301235
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$837.38 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,315.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,909.45
|
| Rate for Payer: Aetna Government |
$2,909.45
|
| Rate for Payer: Brighton Health Commercial |
$1,794.38
|
| 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 |
$1,196.25
|
| Rate for Payer: Group Health Inc Medicare |
$837.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,196.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,196.25
|
|
|
ORBITAL PROSTHESIS, REPLACEMENT
|
Facility
|
OP
|
$533.00
|
|
|
Service Code
|
HCPCS D5928
|
| Hospital Charge Code |
42301280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$293.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$584.91
|
| Rate for Payer: Aetna Government |
$584.91
|
| Rate for Payer: Brighton Health Commercial |
$399.75
|
| 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 |
$266.50
|
| Rate for Payer: Group Health Inc Medicare |
$186.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.50
|
|
