|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$27,250.00
|
|
|
Service Code
|
MSDRG 812
|
| Min. Negotiated Rate |
$7,723.50 |
| Max. Negotiated Rate |
$27,250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,280.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,818.18
|
| Rate for Payer: Aetna Government |
$19,818.18
|
| Rate for Payer: Brighton Health Commercial |
$13,060.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,214.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,554.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,835.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,827.27
|
| Rate for Payer: EmblemHealth Commercial |
$7,723.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,818.18
|
| Rate for Payer: Group Health Inc Commercial |
$19,818.18
|
| Rate for Payer: Group Health Inc Medicare |
$19,818.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,818.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,215.45
|
| Rate for Payer: Humana Medicare |
$27,250.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,818.18
|
| Rate for Payer: United Healthcare Commercial |
$17,912.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,818.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,818.18
|
| Rate for Payer: Wellcare Medicare |
$18,827.27
|
|
|
RED BLOOD CELLS UNIT
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
40701136
|
|
Hospital Revenue Code
|
390
|
| Rate for Payer: Cash Price |
$165.68
|
|
|
RED BLOOD CELLS UNIT
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
40701136
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$115.98 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.68
|
| Rate for Payer: Aetna Government |
$165.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$115.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$115.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$115.98
|
| Rate for Payer: Brighton Health Commercial |
$412.50
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$165.68
|
| Rate for Payer: EmblemHealth Commercial |
$165.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.46
|
| Rate for Payer: Group Health Inc Commercial |
$165.68
|
| Rate for Payer: Group Health Inc Medicare |
$165.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.83
|
| Rate for Payer: Healthfirst QHP |
$165.68
|
| Rate for Payer: Humana Medicare |
$168.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.68
|
| Rate for Payer: United Healthcare Commercial |
$275.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$132.54
|
| Rate for Payer: Wellcare Medicare |
$157.40
|
|
|
Red Rubber Cath.
|
Facility
|
OP
|
$6.38
|
|
| Hospital Charge Code |
40205500
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.19
|
| Rate for Payer: Aetna Government |
$3.19
|
| Rate for Payer: Brighton Health Commercial |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.34
|
| Rate for Payer: Group Health Inc Commercial |
$3.19
|
| Rate for Payer: Group Health Inc Medicare |
$2.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.19
|
|
|
REDUCER CAP MULTISEAL 1 SEAL
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
64902918
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.55 |
| Max. Negotiated Rate |
$58.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.50
|
| Rate for Payer: Aetna Government |
$36.50
|
| Rate for Payer: Brighton Health Commercial |
$54.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.64
|
| Rate for Payer: Group Health Inc Commercial |
$36.50
|
| Rate for Payer: Group Health Inc Medicare |
$25.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.50
|
|
|
REDUCTION OF RECTAL PROLAPSE
|
Facility
|
IP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45900
|
| Hospital Charge Code |
30106503
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,056.92
|
|
|
REDUCTION OF RECTAL PROLAPSE
|
Facility
|
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45900
|
| Hospital Charge Code |
30106503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$739.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$739.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$739.84
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,056.92
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| 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 |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: Humana Medicare |
$1,078.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
REENTRY MALECOT NEPH
|
Facility
|
OP
|
$195.75
|
|
| Hospital Charge Code |
64905392
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.51 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$97.88
|
| Rate for Payer: Aetna Government |
$97.88
|
| Rate for Payer: Brighton Health Commercial |
$146.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$156.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$133.11
|
| Rate for Payer: Group Health Inc Commercial |
$97.88
|
| Rate for Payer: Group Health Inc Medicare |
$68.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.88
|
|
|
RE-EVAL. LIMITED, PROBLEM FOCUSED
|
Facility
|
OP
|
$65.21
|
|
|
Service Code
|
HCPCS D0170
|
| Hospital Charge Code |
42303274
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$152.87
|
| Rate for Payer: Aetna Government |
$152.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$107.01
|
| Rate for Payer: Brighton Health Commercial |
$48.91
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.87
|
| 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 |
$152.87
|
| Rate for Payer: EmblemHealth Commercial |
$152.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.05
|
| Rate for Payer: Group Health Inc Commercial |
$152.87
|
| Rate for Payer: Group Health Inc Medicare |
$152.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.94
|
| Rate for Payer: Healthfirst QHP |
$152.87
|
| Rate for Payer: Humana Medicare |
$155.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$122.30
|
| Rate for Payer: Wellcare Medicare |
$145.23
|
|
|
RE-EVAL. LIMITED, PROBLEM FOCUSED
|
Facility
|
IP
|
$65.21
|
|
|
Service Code
|
HCPCS D0170
|
| Hospital Charge Code |
42303274
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$152.87
|
|
|
REFILL AND MAINTAIN PORTABLE PUMP
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96521
|
| Hospital Charge Code |
40509860
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
REFILL AND MAINTAIN PORTABLE PUMP
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96521
|
| Hospital Charge Code |
40509860
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$173.51 |
| Max. Negotiated Rate |
$445.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$173.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$173.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$173.51
|
| Rate for Payer: Brighton Health Commercial |
$417.38
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$445.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$247.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| Rate for Payer: Group Health Inc Commercial |
$247.87
|
| Rate for Payer: Group Health Inc Medicare |
$247.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Humana Medicare |
$252.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: United Healthcare Commercial |
$278.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
REFILL & MAINTAIN IMPLANTABLE P/R
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
40509861
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$173.51 |
| Max. Negotiated Rate |
$445.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$173.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$173.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$173.51
|
| Rate for Payer: Brighton Health Commercial |
$417.38
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$445.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$247.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| Rate for Payer: Group Health Inc Commercial |
$247.87
|
| Rate for Payer: Group Health Inc Medicare |
$247.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Humana Medicare |
$252.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: United Healthcare Commercial |
$278.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
REFILL & MAINTAIN IMPLANTABLE P/R
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
40509861
|
|
Hospital Revenue Code
|
940
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
REFRACTION
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 92015
|
| Hospital Charge Code |
42101900
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.61
|
| Rate for Payer: Aetna Government |
$16.61
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$149.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
REF SPHER HEAD SCREW 30MM
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.72 |
| Max. Negotiated Rate |
$125.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.72
|
|
|
REF SPHER HEAD SCREW 30MM
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.01 |
| Max. Negotiated Rate |
$264.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$150.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$125.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.58
|
| Rate for Payer: EmblemHealth Commercial |
$125.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$264.02
|
| Rate for Payer: Group Health Inc Commercial |
$125.72
|
| Rate for Payer: Group Health Inc Medicare |
$88.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.44
|
|
|
REFUSED TO PARTICIPATE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2209
|
| Hospital Charge Code |
30300337
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
REGADENOSON 0.4MG/5ML
|
Facility
|
OP
|
$90.63
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
41647934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$59.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.70
|
| Rate for Payer: Aetna Government |
$59.70
|
| Rate for Payer: Brighton Health Commercial |
$54.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52.11
|
| Rate for Payer: Group Health Inc Commercial |
$45.32
|
| Rate for Payer: Group Health Inc Medicare |
$31.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.47
|
| Rate for Payer: SOMOS Essential |
$7.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.91
|
|
|
REGADENOSON 0.4MG/5ML
|
Facility
|
IP
|
$90.63
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
41647934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$45.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.32
|
|
|
REGADENOSON 0.4 MG/5ML IV SOLN [91408]
|
Facility
|
OP
|
$61.86
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
00469650189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$64.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.70
|
| Rate for Payer: Aetna Government |
$59.70
|
| Rate for Payer: Brighton Health Commercial |
$37.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.57
|
| Rate for Payer: EmblemHealth Commercial |
$30.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.96
|
| Rate for Payer: Group Health Inc Commercial |
$30.93
|
| Rate for Payer: Group Health Inc Medicare |
$21.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.21
|
|
|
REGADENOSON 0.4 MG/5ML IV SOLN [91408]
|
Facility
|
IP
|
$60.06
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
60505611600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$30.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.03
|
|
|
REGADENOSON 0.4 MG/5ML IV SOLN [91408]
|
Facility
|
IP
|
$61.86
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
00469650189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$30.93 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.93
|
|
|
REGADENOSON 0.4 MG/5ML IV SOLN [91408]
|
Facility
|
OP
|
$60.06
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
60505611600
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$63.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.70
|
| Rate for Payer: Aetna Government |
$59.70
|
| Rate for Payer: Brighton Health Commercial |
$36.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.53
|
| Rate for Payer: EmblemHealth Commercial |
$30.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.06
|
| Rate for Payer: Group Health Inc Commercial |
$30.03
|
| Rate for Payer: Group Health Inc Medicare |
$21.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.04
|
|
|
REG BONE SCREW 2.7MMX14MM
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$79.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.00
|
|
