|
A/R SCREW SHEATH
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$568.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$568.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$568.00
|
|
|
A/R SCREW TROCHAR
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
|
|
A/R SCREW TROCHAR
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006149
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$192.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.00
|
| Rate for Payer: EmblemHealth Commercial |
$160.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.00
|
| Rate for Payer: Group Health Inc Commercial |
$160.00
|
| Rate for Payer: Group Health Inc Medicare |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.00
|
|
|
ARSENIC BLOOD
|
Facility
|
IP
|
$47.43
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
40609714
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$18.97
|
|
|
ARSENIC BLOOD
|
Facility
|
OP
|
$47.43
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
40607054
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.97
|
| Rate for Payer: Aetna Government |
$18.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.28
|
| Rate for Payer: Brighton Health Commercial |
$35.57
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.97
|
| Rate for Payer: EmblemHealth Commercial |
$18.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.88
|
| Rate for Payer: Group Health Inc Commercial |
$18.97
|
| Rate for Payer: Group Health Inc Medicare |
$18.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.97
|
| Rate for Payer: Healthfirst QHP |
$18.97
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.97
|
| Rate for Payer: United Healthcare Commercial |
$24.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.18
|
| Rate for Payer: Wellcare Medicare |
$17.07
|
|
|
ARSENIC BLOOD
|
Facility
|
IP
|
$47.43
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
40607054
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$18.97
|
|
|
ARSENIC BLOOD
|
Facility
|
OP
|
$47.43
|
|
|
Service Code
|
HCPCS 82175
|
| Hospital Charge Code |
40609714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.97
|
| Rate for Payer: Aetna Government |
$18.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.28
|
| Rate for Payer: Brighton Health Commercial |
$35.57
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Cash Price |
$18.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.97
|
| Rate for Payer: EmblemHealth Commercial |
$18.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.88
|
| Rate for Payer: Group Health Inc Commercial |
$18.97
|
| Rate for Payer: Group Health Inc Medicare |
$18.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.97
|
| Rate for Payer: Healthfirst QHP |
$18.97
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.97
|
| Rate for Payer: United Healthcare Commercial |
$24.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.18
|
| Rate for Payer: Wellcare Medicare |
$17.07
|
|
|
ARTEMETHER-LUMEFANTRINE 20-120 MG PO TABS [96948]
|
Facility
|
OP
|
$6.74
|
|
|
Service Code
|
NDC 00078056845
|
| Hospital Charge Code |
00078056845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.37
|
| Rate for Payer: Aetna Government |
$3.37
|
| Rate for Payer: Brighton Health Commercial |
$5.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.37
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.38
|
|
|
ARTEMETHER/LUMEFANTRINE- COARTEM
|
Facility
|
OP
|
$31.75
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
41640215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$25.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.88
|
| Rate for Payer: Aetna Government |
$15.88
|
| Rate for Payer: Brighton Health Commercial |
$23.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.59
|
| Rate for Payer: Group Health Inc Commercial |
$15.88
|
| Rate for Payer: Group Health Inc Medicare |
$11.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.64
|
|
|
ARTEMETHER/LUMEFANTRINE- COARTEM
|
Facility
|
OP
|
$31.75
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
41650215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$25.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.88
|
| Rate for Payer: Aetna Government |
$15.88
|
| Rate for Payer: Brighton Health Commercial |
$23.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.59
|
| Rate for Payer: Group Health Inc Commercial |
$15.88
|
| Rate for Payer: Group Health Inc Medicare |
$11.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.64
|
|
|
ARTERIAL BLOOD GAS
|
Facility
|
OP
|
$65.18
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
40602310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$48.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$18.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.25
|
| Rate for Payer: Brighton Health Commercial |
$48.88
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Humana Medicare |
$26.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$24.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
ARTERIAL BLOOD GAS
|
Facility
|
IP
|
$65.18
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
40602310
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$26.07
|
|
|
ARTERIAL PRESSURE W/MONITORING
|
Facility
|
OP
|
$174.04
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
66526907
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.54
|
| Rate for Payer: Aetna Government |
$53.54
|
| Rate for Payer: Brighton Health Commercial |
$130.53
|
| 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 |
$87.02
|
| Rate for Payer: Group Health Inc Medicare |
$60.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.02
|
| Rate for Payer: United Healthcare Commercial |
$87.02
|
|
|
ARTERIAL PUNCTURE
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
30103227
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
ARTERIAL PUNCTURE
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
40307000
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$165.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
ARTERIAL PUNCTURE
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
40307000
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
ARTERIAL PUNCTURE
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
30103227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
ARTERIOGRAM RENAL TRAY
|
Facility
|
OP
|
$63.43
|
|
| Hospital Charge Code |
40200350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.72
|
| Rate for Payer: Aetna Government |
$31.72
|
| Rate for Payer: Brighton Health Commercial |
$47.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.13
|
| Rate for Payer: Group Health Inc Commercial |
$31.72
|
| Rate for Payer: Group Health Inc Medicare |
$22.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.72
|
|
|
Arteriovenous anastomosis, open; by upper arm basilic vein transposition
|
Facility
|
OP
|
$6,482.04
|
|
|
Service Code
|
CPT 36819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,482.04 |
| 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: Affinity Essential Plan 1&2 |
$4,448.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,448.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,448.46
|
| 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 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 Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Humana Medicare |
$6,482.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare 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
|
|
|
Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)
|
Facility
|
OP
|
$3,759.80
|
|
|
Service Code
|
CPT 36821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,759.80 |
| 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: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| 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 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 Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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
|
|
|
ARTERY-VEIN AUTOGRAFT
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36825
|
| Hospital Charge Code |
40039834
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
ARTERY-VEIN AUTOGRAFT
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36825
|
| Hospital Charge Code |
40039834
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$10,440.52 |
| 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: Affinity Essential Plan 1&2 |
$4,448.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,448.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,448.46
|
| Rate for Payer: Brighton Health Commercial |
$10,440.52
|
| 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 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 Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Humana Medicare |
$6,482.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare 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
|
|
|
ARTERY X-RAYS ARM/LEG
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Hospital Charge Code |
41103180
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,580.26 |
| Max. Negotiated Rate |
$4,616.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$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 |
$4,056.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,432.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$2,580.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,133.17
|
| 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 |
$3,317.47
|
| Rate for Payer: Group Health Inc Medicare |
$3,317.47
|
| 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 |
$3,317.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,686.08
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare 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
|
|
|
ARTERY X-RAYS ARM/LEG
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Hospital Charge Code |
41103180
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
ARTERY XRAYS ARM/LEG
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Hospital Charge Code |
41102548
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,580.26 |
| Max. Negotiated Rate |
$4,616.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$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 |
$4,056.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,432.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$2,580.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,133.17
|
| 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 |
$3,317.47
|
| Rate for Payer: Group Health Inc Medicare |
$3,317.47
|
| 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 |
$3,317.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,686.08
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare 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
|
|
