|
REMDESIVIR 200MG IN NS 250ML
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
41650319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.06
|
| Rate for Payer: Aetna Government |
$6.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.24
|
| Rate for Payer: Brighton Health Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.06
|
| Rate for Payer: EmblemHealth Commercial |
$6.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.36
|
| Rate for Payer: Group Health Inc Commercial |
$6.06
|
| Rate for Payer: Group Health Inc Medicare |
$6.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.15
|
| Rate for Payer: Healthfirst QHP |
$6.06
|
| Rate for Payer: Humana Medicare |
$6.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.42
|
| Rate for Payer: SOMOS Essential |
$6.42
|
| Rate for Payer: United Healthcare Commercial |
$5.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.85
|
| Rate for Payer: Wellcare Medicare |
$5.76
|
|
|
REMDESIVIR 200MG IN NS 250ML
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
41640319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
|
|
REM EXOSTOSIS-MAXILLA/MANDIBLE
|
Facility
|
OP
|
$1,169.00
|
|
|
Service Code
|
HCPCS D7471
|
| Hospital Charge Code |
42303403
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$272.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$642.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.80
|
| Rate for Payer: Aetna Government |
$272.80
|
| Rate for Payer: Brighton Health Commercial |
$876.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$584.50
|
| Rate for Payer: Group Health Inc Medicare |
$409.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$584.50
|
|
|
REM FB CONJUNCTIVA SUPERFICIAL
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
30305953
|
|
Hospital Revenue Code
|
510
|
| 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 |
$233.00
|
| Rate for Payer: Cash Price |
$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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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: 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 |
$222.00
|
| 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
|
|
|
REM FB CONJUNCTIVA SUPERFICIAL
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
30305953
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
REM FB, CONJUNCTIVA, SUPERFICIAL
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
30103317
|
|
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
|
|
|
REM FB, CONJUNCTIVA, SUPERFICIAL
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 65205
|
| Hospital Charge Code |
30103317
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
REM FR BD FT SUBCU
|
Facility
|
OP
|
$1,823.17
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
42500129
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Brighton Health Commercial |
$1,367.38
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$911.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
REM FR BD FT SUBCU
|
Facility
|
IP
|
$1,823.17
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
42500129
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$813.63
|
|
|
REM IMPAC. TOOTH-COMP BONY/UNUSUA
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS D7241
|
| Hospital Charge Code |
42301675
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$354.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$389.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$531.75
|
| 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 |
$354.50
|
| 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: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare 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
|
|
|
REM IMPAC. TOOTH-COMP BONY/UNUSUA
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
HCPCS D7241
|
| Hospital Charge Code |
42301675
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
REM IMPL CONTRACEP CAPS
|
Facility
|
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
30301256
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| 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 |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
REM IMPL CONTRACEP CAPS
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
30301256
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$813.63
|
|
|
REMIS 12M NOT PHQ-9 SCORE < 5
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9510
|
| Hospital Charge Code |
30307872
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
REMIS 12M PHQ-9 SCORE<5
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9509
|
| Hospital Charge Code |
30307899
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
REM OF NONODONTOGENIC CYST/TUMO/1
|
Facility
|
IP
|
$1,276.00
|
|
|
Service Code
|
HCPCS D7461
|
| Hospital Charge Code |
42301805
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
REM OF NONODONTOGENIC CYST/TUMO/1
|
Facility
|
OP
|
$1,276.00
|
|
|
Service Code
|
HCPCS D7461
|
| Hospital Charge Code |
42301805
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$638.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$701.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$957.00
|
| 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 |
$638.00
|
| 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: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare 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
|
|
|
REM OF NONODONTOGENIC CYST/TUMOR/
|
Facility
|
OP
|
$252.50
|
|
|
Service Code
|
HCPCS D7460
|
| Hospital Charge Code |
42301800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$189.38
|
| 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 |
$126.25
|
| 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: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare 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
|
|
|
REM OF NONODONTOGENIC CYST/TUMOR/
|
Facility
|
IP
|
$252.50
|
|
|
Service Code
|
HCPCS D7460
|
| Hospital Charge Code |
42301800
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
REMOTE 30 DAY ECG REV/REP
|
Facility
|
IP
|
$112.60
|
|
|
Service Code
|
HCPCS 93270
|
| Hospital Charge Code |
30300358
|
|
Hospital Revenue Code
|
731
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
REMOTE 30 DAY ECG REV/REP
|
Facility
|
OP
|
$112.60
|
|
|
Service Code
|
HCPCS 93270
|
| Hospital Charge Code |
30300358
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.61
|
| Rate for Payer: Aetna Government |
$43.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30.53
|
| Rate for Payer: Brighton Health Commercial |
$84.45
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$43.61
|
| Rate for Payer: EmblemHealth Commercial |
$43.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.81
|
| Rate for Payer: Group Health Inc Commercial |
$43.61
|
| Rate for Payer: Group Health Inc Medicare |
$43.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.07
|
| Rate for Payer: Healthfirst QHP |
$43.61
|
| Rate for Payer: Humana Medicare |
$44.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.61
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$41.43
|
|
|
REMOTE AFTERL HD BRACH, 2-12 CHA
|
Facility
|
OP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77771 TC
|
| Hospital Charge Code |
66542962
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,794.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.13
|
| Rate for Payer: Aetna Government |
$829.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$580.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$580.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$580.39
|
| Rate for Payer: Brighton Health Commercial |
$1,682.14
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,794.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,525.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$829.13
|
| Rate for Payer: EmblemHealth Commercial |
$829.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$829.13
|
| Rate for Payer: Group Health Inc Medicare |
$829.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.13
|
| Rate for Payer: Healthfirst QHP |
$829.13
|
| Rate for Payer: Humana Medicare |
$845.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$663.30
|
| Rate for Payer: Wellcare Medicare |
$787.67
|
|
|
REMOTE AFTERL HD BRACH, 2-12 CHA
|
Facility
|
IP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77771 TC
|
| Hospital Charge Code |
66542962
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$829.13
|
|
|
REMOTE AFTERL HIGH DOSE BRCH,1CHA
|
Facility
|
IP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77770 TC
|
| Hospital Charge Code |
66542961
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$829.13
|
|
|
REMOTE AFTERL HIGH DOSE BRCH,1CHA
|
Facility
|
OP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77770 TC
|
| Hospital Charge Code |
66542961
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,794.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.13
|
| Rate for Payer: Aetna Government |
$829.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$580.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$580.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$580.39
|
| Rate for Payer: Brighton Health Commercial |
$1,682.14
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,794.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,525.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$829.13
|
| Rate for Payer: EmblemHealth Commercial |
$829.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$829.13
|
| Rate for Payer: Group Health Inc Medicare |
$829.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.13
|
| Rate for Payer: Healthfirst QHP |
$829.13
|
| Rate for Payer: Humana Medicare |
$845.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$663.30
|
| Rate for Payer: Wellcare Medicare |
$787.67
|
|
