|
AUGMENT TIBIAL HEMI STEPPED WE
|
Facility
IP
|
$5,136.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.12 |
| Max. Negotiated Rate |
$2,568.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,568.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,568.12
|
|
|
AUGMENT TIBIAL HEMI STEPPED WE
|
Facility
OP
|
$5,136.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904860
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,393.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,824.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,568.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,953.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,393.06
|
| Rate for Payer: Group Health Inc Commercial |
$2,568.12
|
| Rate for Payer: Group Health Inc Medicare |
$1,797.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,568.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,568.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,338.56
|
|
|
AURAGAIN SZ 1
|
Facility
OP
|
$211.25
|
|
| Hospital Charge Code |
64903754
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.62
|
| Rate for Payer: Aetna Government |
$105.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$105.62
|
| Rate for Payer: Group Health Inc Medicare |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.62
|
|
|
AURAGAIN SZ1
|
Facility
OP
|
$211.25
|
|
| Hospital Charge Code |
64903756
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.62
|
| Rate for Payer: Aetna Government |
$105.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$105.62
|
| Rate for Payer: Group Health Inc Medicare |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.62
|
|
|
AURAGAIN SZ 2 A
|
Facility
OP
|
$211.25
|
|
| Hospital Charge Code |
64903758
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.62
|
| Rate for Payer: Aetna Government |
$105.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$105.62
|
| Rate for Payer: Group Health Inc Medicare |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.62
|
|
|
AURAGAIN SZ 2 B
|
Facility
OP
|
$211.25
|
|
| Hospital Charge Code |
64903760
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.62
|
| Rate for Payer: Aetna Government |
$105.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$105.62
|
| Rate for Payer: Group Health Inc Medicare |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.62
|
|
|
AURAGAIN SZ 3
|
Facility
OP
|
$211.25
|
|
| Hospital Charge Code |
64903762
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.62
|
| Rate for Payer: Aetna Government |
$105.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$105.62
|
| Rate for Payer: Group Health Inc Medicare |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.62
|
|
|
AURAGAIN SZ 4
|
Facility
OP
|
$21.13
|
|
| Hospital Charge Code |
64903764
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.56
|
| Rate for Payer: Aetna Government |
$10.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.37
|
| Rate for Payer: Group Health Inc Commercial |
$10.56
|
| Rate for Payer: Group Health Inc Medicare |
$7.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.56
|
|
|
AURAGAIN SZ 5
|
Facility
OP
|
$211.25
|
|
| Hospital Charge Code |
64903766
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.62
|
| Rate for Payer: Aetna Government |
$105.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$105.62
|
| Rate for Payer: Group Health Inc Medicare |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.62
|
|
|
AURAGAIN SZ 6
|
Facility
OP
|
$211.25
|
|
| Hospital Charge Code |
64903768
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.62
|
| Rate for Payer: Aetna Government |
$105.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$105.62
|
| Rate for Payer: Group Health Inc Medicare |
$73.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.62
|
|
|
AURICULAR PROSTHESIS
|
Facility
OP
|
$2,910.00
|
|
|
Service Code
|
HCPCS D5914
|
| Hospital Charge Code |
42301230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,018.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,600.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,150.41
|
| Rate for Payer: Aetna Government |
$2,150.41
|
| 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 |
$1,455.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,455.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,455.00
|
|
|
AURICULAR PROSTHESIS, REPLACEMENT
|
Facility
OP
|
$279.00
|
|
|
Service Code
|
HCPCS D5927
|
| Hospital Charge Code |
42301275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$153.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,089.75
|
| Rate for Payer: Aetna Government |
$1,089.75
|
| 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 |
$139.50
|
| Rate for Payer: Group Health Inc Medicare |
$97.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.50
|
|
|
AUSTIAIN
|
Facility
OP
|
$60.95
|
|
| Hospital Charge Code |
40200570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.48
|
| Rate for Payer: Aetna Government |
$30.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.45
|
| Rate for Payer: Group Health Inc Commercial |
$30.48
|
| Rate for Payer: Group Health Inc Medicare |
$21.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.48
|
|
|
AUSTIN MOORE PROSTHESIS
|
Facility
OP
|
$3,925.62
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
40021415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,236.34 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,159.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,236.34
|
| Rate for Payer: Aetna Government |
$1,236.34
|
| 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: Fidelis CHP/HARP/Medicaid |
$1,352.38
|
| Rate for Payer: Group Health Inc Commercial |
$1,962.81
|
| Rate for Payer: Group Health Inc Medicare |
$1,373.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,962.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,962.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,502.65
|
|
|
AUTGRFT IMPLNT KNEE W/SCOOP
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29866
|
| Hospital Charge Code |
40029428
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,196.08 |
| Max. Negotiated Rate |
$9,058.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,196.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,328.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
AUTO/DIR BLOOD PROCESSING FEE
|
Facility
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
40701190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$239.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
AUTO/DIR BLOOD SURCHARGE
|
Facility
OP
|
$287.05
|
|
| Hospital Charge Code |
40701066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.47 |
| Max. Negotiated Rate |
$229.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$157.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$143.52
|
| Rate for Payer: Aetna Government |
$143.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$229.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.19
|
| Rate for Payer: Group Health Inc Commercial |
$143.52
|
| Rate for Payer: Group Health Inc Medicare |
$100.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.52
|
|
|
AUTOINJECTOR
|
Facility
OP
|
$625.00
|
|
| Hospital Charge Code |
64905938
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.50
|
| Rate for Payer: Aetna Government |
$312.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$425.00
|
| Rate for Payer: Group Health Inc Commercial |
$312.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.50
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
IP
|
$106,670.61
|
|
|
Service Code
|
MS-DRG 016
|
| Min. Negotiated Rate |
$43,238.81 |
| Max. Negotiated Rate |
$106,670.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91,079.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$92,986.69
|
| Rate for Payer: Aetna Government |
$92,986.69
|
| Rate for Payer: Brighton Health Commercial |
$89,566.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94,846.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106,670.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88,029.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$88,337.36
|
| Rate for Payer: EmblemHealth Commercial |
$52,967.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$92,986.69
|
| Rate for Payer: Group Health Inc Commercial |
$92,986.69
|
| Rate for Payer: Group Health Inc Medicare |
$92,986.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92,986.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43,238.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92,986.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92,986.69
|
| Rate for Payer: Wellcare Medicare |
$88,337.36
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
IP
|
$106,670.61
|
|
|
Service Code
|
MS-DRG 017
|
| Min. Negotiated Rate |
$43,238.81 |
| Max. Negotiated Rate |
$106,670.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91,079.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$92,986.69
|
| Rate for Payer: Aetna Government |
$92,986.69
|
| Rate for Payer: Brighton Health Commercial |
$89,566.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94,846.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106,670.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88,029.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$88,337.36
|
| Rate for Payer: EmblemHealth Commercial |
$52,967.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$92,986.69
|
| Rate for Payer: Group Health Inc Commercial |
$92,986.69
|
| Rate for Payer: Group Health Inc Medicare |
$92,986.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92,986.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43,238.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92,986.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92,986.69
|
| Rate for Payer: Wellcare Medicare |
$88,337.36
|
|
|
AUTOMATED RBC COUNT
|
Facility
OP
|
$7.55
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
40629618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.02
|
| Rate for Payer: EmblemHealth Commercial |
$3.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.69
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.02
|
| Rate for Payer: Healthfirst QHP |
$3.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.42
|
| Rate for Payer: Wellcare Medicare |
$2.72
|
|
|
AUTOMATED RBC COUNT
|
Facility
OP
|
$7.55
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
30305607
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.02
|
| Rate for Payer: EmblemHealth Commercial |
$3.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.69
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.02
|
| Rate for Payer: Healthfirst QHP |
$3.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.42
|
| Rate for Payer: Wellcare Medicare |
$2.72
|
|
|
AUTOPSY
|
Facility
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 88000
|
| Hospital Charge Code |
40635414
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$148.15 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$825.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$148.15
|
| Rate for Payer: Aetna Government |
$148.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$219.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$185.74
|
| Rate for Payer: Group Health Inc Commercial |
$750.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.00
|
|
|
AUTOSUTURE ENDO CLIP LG
|
Facility
OP
|
$1,105.54
|
|
| Hospital Charge Code |
40205113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$386.94 |
| Max. Negotiated Rate |
$884.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$608.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$552.77
|
| Rate for Payer: Aetna Government |
$552.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$884.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$751.77
|
| Rate for Payer: Group Health Inc Commercial |
$552.77
|
| Rate for Payer: Group Health Inc Medicare |
$386.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$552.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$552.77
|
|
|
AUTO SUTURE (GIA50)
|
Facility
OP
|
$256.92
|
|
| Hospital Charge Code |
40202210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.92 |
| Max. Negotiated Rate |
$205.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$141.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$128.46
|
| Rate for Payer: Aetna Government |
$128.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$205.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$174.71
|
| Rate for Payer: Group Health Inc Commercial |
$128.46
|
| Rate for Payer: Group Health Inc Medicare |
$89.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.46
|
|
