|
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 19286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$390.81
|
| Rate for Payer: Aetna Government |
$390.81
|
| 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: United Healthcare Commercial |
$1,113.00
|
|
|
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 19281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,874.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 19281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 19285
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 19285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
PLACEMENT OF GASTROSTOMY TUBE
|
Facility
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
30106501
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
|
PLACEMENT OF GASTROSTOMY TUBE
|
Facility
|
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43246
|
| Hospital Charge Code |
30106501
|
|
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 |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,540.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,540.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,540.32
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,200.46
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| 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 |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Humana Medicare |
$2,244.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 50432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)
|
Facility
|
OP
|
$6,937.00
|
|
|
Service Code
|
CPT G0269
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.12
|
| Rate for Payer: Aetna Government |
$14.12
|
| 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: United Healthcare Commercial |
$1,113.00
|
|
|
Placement of seton
|
Facility
|
OP
|
$3,311.93
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,311.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,272.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,272.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,272.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| 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 |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Humana Medicare |
$3,311.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$7,099.93
|
|
|
Service Code
|
HCPCS 46020
|
| Hospital Charge Code |
40019945
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,324.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,272.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,272.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,272.89
|
| Rate for Payer: Brighton Health Commercial |
$5,324.95
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| 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 |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,549.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Humana Medicare |
$3,311.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
PLACEMENT OF SETON
|
Facility
|
IP
|
$7,099.93
|
|
|
Service Code
|
HCPCS 46020
|
| Hospital Charge Code |
40019945
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,246.99
|
|
|
PLACE NEEDLE INTRAOSSEOUS INFUSIO
|
Facility
|
IP
|
$1,101.23
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
30103315
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$460.76
|
|
|
PLACE NEEDLE INTRAOSSEOUS INFUSIO
|
Facility
|
OP
|
$1,101.23
|
|
|
Service Code
|
HCPCS 36680
|
| Hospital Charge Code |
30103315
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$460.76
|
| Rate for Payer: Aetna Government |
$460.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.53
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$460.76
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$460.76
|
| 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 |
$460.76
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$460.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.08
|
| 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 |
$550.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$460.76
|
| Rate for Payer: Humana Medicare |
$469.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$460.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$460.76
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$460.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$460.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.61
|
| Rate for Payer: Wellcare Medicare |
$437.72
|
|
|
PLAIN GAUZE 1/2 SIZE
|
Facility
|
OP
|
$15.24
|
|
| Hospital Charge Code |
40204803
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$12.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.62
|
| Rate for Payer: Aetna Government |
$7.62
|
| Rate for Payer: Brighton Health Commercial |
$11.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.36
|
| Rate for Payer: Group Health Inc Commercial |
$7.62
|
| Rate for Payer: Group Health Inc Medicare |
$5.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.62
|
|
|
PLAIN GAUZE 1 SIZE
|
Facility
|
OP
|
$15.24
|
|
| Hospital Charge Code |
40204804
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$12.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.62
|
| Rate for Payer: Aetna Government |
$7.62
|
| Rate for Payer: Brighton Health Commercial |
$11.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.36
|
| Rate for Payer: Group Health Inc Commercial |
$7.62
|
| Rate for Payer: Group Health Inc Medicare |
$5.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.62
|
|
|
PLAIN GAUZE 2 SIZE
|
Facility
|
OP
|
$4.03
|
|
| Hospital Charge Code |
40204805
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.02
|
| Rate for Payer: Aetna Government |
$2.02
|
| Rate for Payer: Brighton Health Commercial |
$3.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.74
|
| Rate for Payer: Group Health Inc Commercial |
$2.02
|
| Rate for Payer: Group Health Inc Medicare |
$1.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.02
|
|
|
PLAN OF CARE 4 PAIN DOCD
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 0521F
|
| Hospital Charge Code |
30305813
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
PLANTAR FASCIOTOMY
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
40082715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| 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: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| 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 Medicaid |
$4,145.52
|
| 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
|
|
|
PLANTAR FASCIOTOMY
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
40082715
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
PLASMABLADE 3.0S SPATULA TIP
|
Facility
|
OP
|
$969.38
|
|
| Hospital Charge Code |
64904857
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$339.28 |
| Max. Negotiated Rate |
$775.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$533.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$484.69
|
| Rate for Payer: Aetna Government |
$484.69
|
| Rate for Payer: Brighton Health Commercial |
$727.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$775.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$659.18
|
| Rate for Payer: Group Health Inc Commercial |
$484.69
|
| Rate for Payer: Group Health Inc Medicare |
$339.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$484.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$484.69
|
|
|
PLASMA PHERESIS
|
Facility
|
IP
|
$4,008.93
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
40708602
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,774.33
|
|
|
PLASMA PHERESIS
|
Facility
|
OP
|
$4,008.93
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
40708602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,242.03 |
| Max. Negotiated Rate |
$3,006.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,774.33
|
| Rate for Payer: Aetna Government |
$1,774.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,242.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,242.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,242.03
|
| Rate for Payer: Brighton Health Commercial |
$3,006.70
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,774.33
|
| 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 |
$1,774.33
|
| Rate for Payer: EmblemHealth Commercial |
$1,774.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,508.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,579.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,774.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,579.15
|
| Rate for Payer: Group Health Inc Commercial |
$1,774.33
|
| Rate for Payer: Group Health Inc Medicare |
$1,774.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,004.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,774.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,508.18
|
| Rate for Payer: Healthfirst QHP |
$1,774.33
|
| Rate for Payer: Humana Medicare |
$1,809.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,774.33
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,774.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,774.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,419.46
|
| Rate for Payer: Wellcare Medicare |
$1,685.61
|
|
|
PLASMAPHERESIS
|
Facility
|
OP
|
$4,008.93
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
42900002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,242.03 |
| Max. Negotiated Rate |
$3,006.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,774.33
|
| Rate for Payer: Aetna Government |
$1,774.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,242.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,242.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,242.03
|
| Rate for Payer: Brighton Health Commercial |
$3,006.70
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,774.33
|
| 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 |
$1,774.33
|
| Rate for Payer: EmblemHealth Commercial |
$1,774.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,508.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,579.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,774.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,579.15
|
| Rate for Payer: Group Health Inc Commercial |
$1,774.33
|
| Rate for Payer: Group Health Inc Medicare |
$1,774.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,004.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,774.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,508.18
|
| Rate for Payer: Healthfirst QHP |
$1,774.33
|
| Rate for Payer: Humana Medicare |
$1,809.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,774.33
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,774.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,774.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,419.46
|
| Rate for Payer: Wellcare Medicare |
$1,685.61
|
|
|
PLASMAPHERESIS
|
Facility
|
IP
|
$4,008.93
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
42900002
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,774.33
|
|
