|
SIMVASTATIN 10 MG TAB
|
Facility
OP
|
$0.20
|
|
| Hospital Charge Code |
41652624
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SIMVASTATIN 20 MG TAB
|
Facility
OP
|
$0.20
|
|
| Hospital Charge Code |
41642621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SIMVASTATIN 20 MG TAB
|
Facility
OP
|
$0.20
|
|
| Hospital Charge Code |
41652621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SIMVASTATIN 40 MG TAB
|
Facility
OP
|
$0.20
|
|
| Hospital Charge Code |
41652920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SIMVASTATIN 40 MG TAB
|
Facility
OP
|
$0.20
|
|
| Hospital Charge Code |
41642920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SINCALIDE 5 MCG INJ
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
41651796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$137.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.08
|
| Rate for Payer: Aetna Government |
$121.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.19
|
| Rate for Payer: Group Health Inc Commercial |
$28.00
|
| Rate for Payer: Group Health Inc Medicare |
$19.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.53
|
| Rate for Payer: SOMOS Essential |
$137.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.40
|
|
|
SINCALIDE 5 MCG INJ
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
41641796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$137.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.08
|
| Rate for Payer: Aetna Government |
$121.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.19
|
| Rate for Payer: Group Health Inc Commercial |
$28.00
|
| Rate for Payer: Group Health Inc Medicare |
$19.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.53
|
| Rate for Payer: SOMOS Essential |
$137.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.40
|
|
|
SINCALIDE 5 MCG INJ
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
41651796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.00
|
|
|
SINCALIDE 5 MCG INJ
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
41641796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.00
|
|
|
SINGLE ACTION PUMP SYSTEM
|
Facility
OP
|
$224.00
|
|
| Hospital Charge Code |
40205957
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$179.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.00
|
| Rate for Payer: Aetna Government |
$112.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$179.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$152.32
|
| Rate for Payer: Group Health Inc Commercial |
$112.00
|
| Rate for Payer: Group Health Inc Medicare |
$78.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.00
|
|
|
SINGLE CHAMBER PCMKR CHECK
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93279 TC
|
| Hospital Charge Code |
40804104
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.36
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.96
|
|
|
SINGLE CR 3/4 CAST HIGH NOBLE MET
|
Facility
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D2780
|
| Hospital Charge Code |
42303292
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE CROWN 3/4 CAST BASE METAL
|
Facility
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D2781
|
| Hospital Charge Code |
42303293
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE CROWN 3/4 CAST NOBLE METAL
|
Facility
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D2782
|
| Hospital Charge Code |
42303294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE CROWN 3/4 PORC/CERAM
|
Facility
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS D2783
|
| Hospital Charge Code |
42303295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$715.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE/DUAL ICD
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93289 TC
|
| Hospital Charge Code |
30305067
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.00
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.55
|
|
|
SINGLE LEAD ICD W/REPROGRAM
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93282 TC
|
| Hospital Charge Code |
30305064
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.32
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.25
|
|
|
SINGLE LEAD PACE W/REPROGRAM
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93279 TC
|
| Hospital Charge Code |
30305061
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.36
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.96
|
|
|
SINGLE ONLAY MET 4 OR MORE SURF.
|
Facility
OP
|
$1,169.44
|
|
|
Service Code
|
HCPCS D2544
|
| Hospital Charge Code |
42303285
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$584.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$643.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE ONLAY MET THREE SURFACES
|
Facility
OP
|
$1,169.44
|
|
|
Service Code
|
HCPCS D2543
|
| Hospital Charge Code |
42303284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$584.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$643.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE ONLAY MET TWO SURFACES
|
Facility
OP
|
$1,169.44
|
|
|
Service Code
|
HCPCS D2542
|
| Hospital Charge Code |
42303283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$584.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$643.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE ONLAY PORC/CERAM 2 SURF.
|
Facility
OP
|
$1,169.44
|
|
|
Service Code
|
HCPCS D2642
|
| Hospital Charge Code |
42303286
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$584.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$643.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE ONLAY PORC/CERAM 3 SURF.
|
Facility
OP
|
$1,169.44
|
|
|
Service Code
|
HCPCS D2643
|
| Hospital Charge Code |
42303287
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$584.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$643.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE ONLAY PORC/CERAM 4 + SURF.
|
Facility
OP
|
$1,353.71
|
|
|
Service Code
|
HCPCS D2644
|
| Hospital Charge Code |
42303288
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$676.86 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$744.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$676.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SINGLE ONLAY RES-BASE COMP 4+SURF
|
Facility
OP
|
$1,169.44
|
|
|
Service Code
|
HCPCS D2664
|
| Hospital Charge Code |
42303291
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$584.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$643.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
