|
AUTO SUTURE (TA30)
|
Facility
OP
|
$3.75
|
|
| Hospital Charge Code |
40202222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.88
|
| Rate for Payer: Aetna Government |
$1.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.88
|
| Rate for Payer: Group Health Inc Medicare |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.88
|
|
|
AUTO TISSUE GRAFT ADDL TOOTH
|
Facility
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS D4283
|
| Hospital Charge Code |
42303464
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$687.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$526.58
|
| Rate for Payer: Aetna Government |
$526.58
|
| 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 |
$625.00
|
| Rate for Payer: Group Health Inc Medicare |
$437.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.00
|
|
|
AUTOVALVE QUICK ABVISER
|
Facility
OP
|
$229.48
|
|
| Hospital Charge Code |
64902814
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.32 |
| Max. Negotiated Rate |
$183.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.74
|
| Rate for Payer: Aetna Government |
$114.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.05
|
| Rate for Payer: Group Health Inc Commercial |
$114.74
|
| Rate for Payer: Group Health Inc Medicare |
$80.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.74
|
|
|
AVENIR MULLER STANDARD STEM 3
|
Facility
IP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,992.00 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
|
|
AVENIR MULLER STANDARD STEM 3
|
Facility
OP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$14,683.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,691.20
|
| 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 |
$6,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,040.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,683.20
|
| Rate for Payer: Group Health Inc Commercial |
$6,992.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,894.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,089.60
|
|
|
AVENIR MULLER STANDARD STEM 3
|
Facility
IP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,992.00 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
|
|
AVENIR MULLER STANDARD STEM 3
|
Facility
OP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$14,683.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,691.20
|
| 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 |
$6,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,040.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,683.20
|
| Rate for Payer: Group Health Inc Commercial |
$6,992.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,894.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,089.60
|
|
|
AVENIR MULLER STRD STEM 2
|
Facility
IP
|
$11,670.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,835.00 |
| Max. Negotiated Rate |
$5,835.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,835.00
|
|
|
AVENIR MULLER STRD STEM 2
|
Facility
OP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$14,683.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,691.20
|
| 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 |
$6,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,040.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,683.20
|
| Rate for Payer: Group Health Inc Commercial |
$6,992.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,894.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,089.60
|
|
|
AVENIR MULLER STRD STEM 2
|
Facility
OP
|
$11,670.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$12,253.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,418.50
|
| 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 |
$5,835.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,710.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,253.50
|
| Rate for Payer: Group Health Inc Commercial |
$5,835.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,084.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,835.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,585.50
|
|
|
AVENIR MULLER STRD STEM 2
|
Facility
IP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,992.00 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
|
|
AVENIR MULLER STRD STEM 2
|
Facility
IP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,992.00 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
|
|
AVENIR MULLER STRD STEM 2
|
Facility
OP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204593
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$14,683.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,691.20
|
| 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 |
$6,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,040.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,683.20
|
| Rate for Payer: Group Health Inc Commercial |
$6,992.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,894.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,089.60
|
|
|
AV FISTULA CREATION ARM/CEPHALIC
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36818
|
| Hospital Charge Code |
40039817
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$787.21 |
| Max. Negotiated Rate |
$6,960.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$6,354.94
|
| Rate for Payer: Group Health Inc Medicare |
$6,354.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$874.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
AV FUSION DIRECT ANY SITE
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36821
|
| Hospital Charge Code |
40039943
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$754.86 |
| Max. Negotiated Rate |
$4,196.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$754.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$838.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
AV FUSION UPPER ARM VEIN
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36819
|
| Hospital Charge Code |
40034064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$834.23 |
| Max. Negotiated Rate |
$6,960.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$834.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$6,354.94
|
| Rate for Payer: Group Health Inc Medicare |
$6,354.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$926.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
A-V GRAFT
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36831
|
| Hospital Charge Code |
40031805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.03 |
| Max. Negotiated Rate |
$6,960.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$704.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$6,354.94
|
| Rate for Payer: Group Health Inc Medicare |
$6,354.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$782.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
A-V GRAFT
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36830
|
| Hospital Charge Code |
30300012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$6,960.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$760.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$844.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6,354.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
AVITENE
|
Facility
OP
|
$159.12
|
|
| Hospital Charge Code |
40207017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.56
|
| Rate for Payer: Aetna Government |
$79.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$127.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.20
|
| Rate for Payer: Group Health Inc Commercial |
$79.56
|
| Rate for Payer: Group Health Inc Medicare |
$55.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.56
|
|
|
AVITENE COLLAGEN HEMOSTATE LGM
|
Facility
OP
|
$289.34
|
|
| Hospital Charge Code |
40205975
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.27 |
| Max. Negotiated Rate |
$231.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$159.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.67
|
| Rate for Payer: Aetna Government |
$144.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$231.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$196.75
|
| Rate for Payer: Group Health Inc Commercial |
$144.67
|
| Rate for Payer: Group Health Inc Medicare |
$101.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.67
|
|
|
Avulsion of nail plate, partial or complete, simple; single
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.11 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
Avulsion of nail plate, partial or complete, simple; single
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.11 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
AWL
|
Facility
OP
|
$2,352.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,469.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,293.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,352.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,469.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,176.00
|
| Rate for Payer: Group Health Inc Medicare |
$823.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,176.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,176.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,528.80
|
|
|
AWL
|
Facility
IP
|
$2,352.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.00 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,176.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,176.00
|
|
|
AXILLARY NERVE
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64417
|
| Hospital Charge Code |
30305028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
