|
PERAMPANEL 12MG TABLETS
|
Facility
|
OP
|
$33.39
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
41640361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$26.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.70
|
| Rate for Payer: Aetna Government |
$16.70
|
| Rate for Payer: Brighton Health Commercial |
$25.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.71
|
| Rate for Payer: Group Health Inc Commercial |
$16.70
|
| Rate for Payer: Group Health Inc Medicare |
$11.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.70
|
|
|
PERAMPANEL 2 MG PO TABS [124441]
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 62856027230
|
| Hospital Charge Code |
62856027230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$19.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.42
|
| Rate for Payer: Aetna Government |
$12.42
|
| Rate for Payer: Brighton Health Commercial |
$18.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.89
|
| Rate for Payer: Group Health Inc Commercial |
$12.42
|
| Rate for Payer: Group Health Inc Medicare |
$8.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.15
|
|
|
PERAMPANEL 2MG TAB
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
41655967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
PERAMPANEL 2MG TAB
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
41645967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
PERC CORONARY THOMBECT, MECHANICA
|
Facility
|
OP
|
$31,452.50
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
66523481
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$17,298.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,298.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.49
|
| Rate for Payer: Aetna Government |
$165.49
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,959.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,215.78
|
| Rate for Payer: Group Health Inc Commercial |
$15,726.25
|
| Rate for Payer: Group Health Inc Medicare |
$11,008.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,726.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,726.25
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
PERC OF ABSCESS FLUORO
|
Facility
|
OP
|
$453.64
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
41542628
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$362.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$249.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.95
|
| Rate for Payer: Aetna Government |
$64.95
|
| Rate for Payer: Brighton Health Commercial |
$340.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$362.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$308.48
|
| Rate for Payer: Group Health Inc Commercial |
$226.82
|
| Rate for Payer: Group Health Inc Medicare |
$158.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.82
|
|
|
PERCUFLEX 6.0X26 W/O WIRE
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.00
|
|
|
PERCUFLEX 6.0X26 W/O WIRE
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$144.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.00
|
| Rate for Payer: EmblemHealth Commercial |
$120.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.00
|
| Rate for Payer: Group Health Inc Commercial |
$120.00
|
| Rate for Payer: Group Health Inc Medicare |
$84.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.00
|
|
|
PERCUFLEX 6.0X28 W/O WIRE
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$170.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$186.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.25
|
| Rate for Payer: EmblemHealth Commercial |
$155.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$325.50
|
| Rate for Payer: Group Health Inc Commercial |
$155.00
|
| Rate for Payer: Group Health Inc Medicare |
$108.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.50
|
|
|
PERCUFLEX 6.0X28 W/O WIRE
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200995
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.00 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.00
|
|
|
PERCUT ALLERGY TITRATE TEST
|
Facility
|
IP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
30301410
|
|
Hospital Revenue Code
|
924
|
| Rate for Payer: Cash Price |
$1,209.08
|
|
|
PERCUT ALLERGY TITRATE TEST
|
Facility
|
OP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
30301410
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$846.36 |
| Max. Negotiated Rate |
$2,202.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,514.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,209.08
|
| Rate for Payer: Aetna Government |
$1,209.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$846.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$846.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$846.36
|
| Rate for Payer: Brighton Health Commercial |
$2,064.74
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,209.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,202.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,872.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,209.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,209.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,027.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,076.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,209.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,076.08
|
| Rate for Payer: Group Health Inc Commercial |
$1,209.08
|
| Rate for Payer: Group Health Inc Medicare |
$1,209.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,209.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,027.72
|
| Rate for Payer: Healthfirst QHP |
$1,209.08
|
| Rate for Payer: Humana Medicare |
$1,233.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,209.08
|
| Rate for Payer: United Healthcare Commercial |
$1,376.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,209.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,209.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$967.26
|
| Rate for Payer: Wellcare Medicare |
$1,148.63
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$84,382.44
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$28,536.61 |
| Max. Negotiated Rate |
$84,382.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57,461.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61,369.05
|
| Rate for Payer: Aetna Government |
$61,369.05
|
| Rate for Payer: Brighton Health Commercial |
$56,506.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62,596.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67,297.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55,536.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$58,300.60
|
| Rate for Payer: EmblemHealth Commercial |
$33,416.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$61,369.05
|
| Rate for Payer: Group Health Inc Commercial |
$61,369.05
|
| Rate for Payer: Group Health Inc Medicare |
$61,369.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61,369.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28,536.61
|
| Rate for Payer: Humana Medicare |
$84,382.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61,369.05
|
| Rate for Payer: United Healthcare Commercial |
$77,499.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61,369.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61,369.05
|
| Rate for Payer: Wellcare Medicare |
$58,300.60
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$71,870.22
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$24,305.20 |
| Max. Negotiated Rate |
$71,870.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47,785.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52,269.25
|
| Rate for Payer: Aetna Government |
$52,269.25
|
| Rate for Payer: Brighton Health Commercial |
$46,991.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53,314.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55,965.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46,185.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$49,655.79
|
| Rate for Payer: EmblemHealth Commercial |
$27,789.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$52,269.25
|
| Rate for Payer: Group Health Inc Commercial |
$52,269.25
|
| Rate for Payer: Group Health Inc Medicare |
$52,269.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52,269.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24,305.20
|
| Rate for Payer: Humana Medicare |
$71,870.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52,269.25
|
| Rate for Payer: United Healthcare Commercial |
$64,449.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52,269.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52,269.25
|
| Rate for Payer: Wellcare Medicare |
$49,655.79
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$64,889.55
|
|
|
Service Code
|
MSDRG 321
|
| Min. Negotiated Rate |
$21,944.47 |
| Max. Negotiated Rate |
$64,889.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42,387.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47,192.40
|
| Rate for Payer: Aetna Government |
$47,192.40
|
| Rate for Payer: Brighton Health Commercial |
$41,683.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48,136.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49,643.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40,967.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$44,832.78
|
| Rate for Payer: EmblemHealth Commercial |
$24,650.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$47,192.40
|
| Rate for Payer: Group Health Inc Commercial |
$47,192.40
|
| Rate for Payer: Group Health Inc Medicare |
$47,192.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47,192.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21,944.47
|
| Rate for Payer: Humana Medicare |
$64,889.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47,192.40
|
| Rate for Payer: United Healthcare Commercial |
$57,169.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47,192.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47,192.40
|
| Rate for Payer: Wellcare Medicare |
$44,832.78
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$44,843.73
|
|
|
Service Code
|
MSDRG 322
|
| Min. Negotiated Rate |
$15,165.33 |
| Max. Negotiated Rate |
$44,843.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,886.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,613.62
|
| Rate for Payer: Aetna Government |
$32,613.62
|
| Rate for Payer: Brighton Health Commercial |
$26,439.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,265.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,488.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,985.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,982.94
|
| Rate for Payer: EmblemHealth Commercial |
$15,635.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,613.62
|
| Rate for Payer: Group Health Inc Commercial |
$32,613.62
|
| Rate for Payer: Group Health Inc Medicare |
$32,613.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,613.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,165.33
|
| Rate for Payer: Humana Medicare |
$44,843.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,613.62
|
| Rate for Payer: United Healthcare Commercial |
$36,261.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,613.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,613.62
|
| Rate for Payer: Wellcare Medicare |
$30,982.94
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$54,900.02
|
|
|
Service Code
|
MSDRG 250
|
| Min. Negotiated Rate |
$18,566.19 |
| Max. Negotiated Rate |
$54,900.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34,662.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39,927.29
|
| Rate for Payer: Aetna Government |
$39,927.29
|
| Rate for Payer: Brighton Health Commercial |
$34,086.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40,725.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40,595.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33,501.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$37,930.93
|
| Rate for Payer: EmblemHealth Commercial |
$20,158.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$39,927.29
|
| Rate for Payer: Group Health Inc Commercial |
$39,927.29
|
| Rate for Payer: Group Health Inc Medicare |
$39,927.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39,927.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,566.19
|
| Rate for Payer: Humana Medicare |
$54,900.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39,927.29
|
| Rate for Payer: United Healthcare Commercial |
$46,750.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39,927.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39,927.29
|
| Rate for Payer: Wellcare Medicare |
$37,930.93
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$40,334.22
|
|
|
Service Code
|
MSDRG 251
|
| Min. Negotiated Rate |
$13,607.70 |
| Max. Negotiated Rate |
$40,334.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,398.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,333.98
|
| Rate for Payer: Aetna Government |
$29,333.98
|
| Rate for Payer: Brighton Health Commercial |
$23,010.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,920.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,404.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,615.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,867.28
|
| Rate for Payer: EmblemHealth Commercial |
$13,607.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,333.98
|
| Rate for Payer: Group Health Inc Commercial |
$29,333.98
|
| Rate for Payer: Group Health Inc Medicare |
$29,333.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,333.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,640.30
|
| Rate for Payer: Humana Medicare |
$40,334.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,333.98
|
| Rate for Payer: United Healthcare Commercial |
$31,558.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,333.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,333.98
|
| Rate for Payer: Wellcare Medicare |
$27,867.28
|
|
|
Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed
|
Facility
|
OP
|
$406,911.00
|
|
|
Service Code
|
CPT 64561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$406,911.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,908.94
|
| Rate for Payer: Aetna Government |
$7,908.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9,155.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9,155.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,069.11
|
| Rate for Payer: Amida Care Medicaid |
$4,069.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,908.94
|
| 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 |
$7,908.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$406,911.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,069.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,069.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,908.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,272.57
|
| Rate for Payer: Group Health Inc Commercial |
$7,908.94
|
| Rate for Payer: Group Health Inc Medicare |
$7,908.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,069.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,908.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,069.11
|
| Rate for Payer: Healthfirst Essential Plan |
$9,155.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,722.60
|
| Rate for Payer: Healthfirst QHP |
$4,069.11
|
| Rate for Payer: Humana Medicare |
$8,067.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,908.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,069.11
|
| Rate for Payer: SOMOS Essential |
$9,155.50
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$9,155.50
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$4,476.02
|
| Rate for Payer: United Healthcare Medicaid |
$4,069.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,908.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,908.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,327.15
|
| Rate for Payer: Wellcare Medicare |
$7,513.49
|
|
|
Percutaneous portal vein catheterization by any method
|
Facility
|
OP
|
$4,065.00
|
|
|
Service Code
|
CPT 36481
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.51 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$372.51
|
| Rate for Payer: Aetna Government |
$372.51
|
| 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: United Healthcare Commercial |
$1,113.00
|
|
|
Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each
|
Facility
|
OP
|
$4,065.00
|
|
|
Service Code
|
CPT 26727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
PERCUTANEOUS TESTS
|
Facility
|
IP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
30301409
|
|
Hospital Revenue Code
|
924
|
| Rate for Payer: Cash Price |
$1,209.08
|
|
|
PERCUTANEOUS TESTS
|
Facility
|
OP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 95004
|
| Hospital Charge Code |
30301409
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$846.36 |
| Max. Negotiated Rate |
$2,202.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,514.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,209.08
|
| Rate for Payer: Aetna Government |
$1,209.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$846.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$846.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$846.36
|
| Rate for Payer: Brighton Health Commercial |
$2,064.74
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,209.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,202.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,872.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,209.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,209.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,027.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,076.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,209.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,076.08
|
| Rate for Payer: Group Health Inc Commercial |
$1,209.08
|
| Rate for Payer: Group Health Inc Medicare |
$1,209.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,209.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,027.72
|
| Rate for Payer: Healthfirst QHP |
$1,209.08
|
| Rate for Payer: Humana Medicare |
$1,233.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,209.08
|
| Rate for Payer: United Healthcare Commercial |
$1,376.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,209.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,209.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$967.26
|
| Rate for Payer: Wellcare Medicare |
$1,148.63
|
|
|
PERCUTANEOUS, TOE, SINGLE TENDON
|
Facility
|
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
42500222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,301.03 |
| Max. Negotiated Rate |
$3,078.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,301.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,301.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,301.03
|
| Rate for Payer: Brighton Health Commercial |
$3,078.85
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,858.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| Rate for Payer: Group Health Inc Commercial |
$1,858.61
|
| Rate for Payer: Group Health Inc Medicare |
$1,858.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Humana Medicare |
$1,895.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
PERCUTANEOUS, TOE, SINGLE TENDON
|
Facility
|
IP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
42500222
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,858.61
|
|
