|
THERAPEUTIC APHERESIS
|
Facility
OP
|
$4,008.93
|
|
|
Service Code
|
HCPCS 36511
|
| Hospital Charge Code |
40701199
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.52 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,774.33
|
| Rate for Payer: Aetna Government |
$1,774.33
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,774.33
|
| 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 |
$1,774.33
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,508.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,579.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,774.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,579.15
|
| Rate for Payer: Group Health Inc Commercial |
$1,774.33
|
| Rate for Payer: Group Health Inc Medicare |
$1,774.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,004.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,774.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,508.18
|
| Rate for Payer: Healthfirst QHP |
$1,774.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,774.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,774.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,419.46
|
| Rate for Payer: Wellcare Medicare |
$1,685.61
|
|
|
THERAPEUTIC APHERESIS FOR PLASMA
|
Facility
OP
|
$4,008.93
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
30301510
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,774.33
|
| Rate for Payer: Aetna Government |
$1,774.33
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Cash Price |
$1,774.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,774.33
|
| 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 |
$1,774.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,508.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,579.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,774.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,579.15
|
| 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 |
$2,004.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,774.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,508.18
|
| Rate for Payer: Healthfirst QHP |
$1,774.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,774.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,774.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,774.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,419.46
|
| Rate for Payer: Wellcare Medicare |
$1,685.61
|
|
|
THERAPEUTIC BEHAVIORAL SERVICES
|
Facility
OP
|
$250.63
|
|
|
Service Code
|
HCPCS H2020
|
| Hospital Charge Code |
30302057
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$200.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.36
|
| Rate for Payer: Aetna Government |
$31.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.43
|
| Rate for Payer: Group Health Inc Commercial |
$125.32
|
| Rate for Payer: Group Health Inc Medicare |
$87.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.32
|
|
|
THERAPEUTIC DRUG INJECTION, BY RE
|
Facility
OP
|
$37.50
|
|
|
Service Code
|
HCPCS D9610
|
| Hospital Charge Code |
42302355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.47
|
| Rate for Payer: Aetna Government |
$14.47
|
| 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 |
$18.75
|
| Rate for Payer: Group Health Inc Medicare |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.75
|
|
|
THERAPEUTIC EXERCISE-GROUP
|
Facility
OP
|
$52.88
|
|
|
Service Code
|
HCPCS 97150
|
| Hospital Charge Code |
41701004
|
|
Hospital Revenue Code
|
429
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.34
|
| Rate for Payer: Aetna Government |
$10.34
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.55
|
| Rate for Payer: Group Health Inc Commercial |
$26.44
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.61
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
THERAPEUTIC IM
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
30103280
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Healthfirst Essential Plan |
$13.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$13.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$13.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
THERAPEUTIC INFUSION
|
Facility
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
40509874
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.38 |
| 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: 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 CHP/HARP/Medicaid |
$35.38
|
| 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 CHP/FHP/Medicaid |
$39.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Senior Whole Health 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
|
|
|
THERAPEUTIC INJECTION IM/SQ
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
40509863
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Healthfirst Essential Plan |
$13.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$13.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$13.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
THERAPEUTIC PULPOTOMY (EXCLUDING
|
Facility
OP
|
$217.50
|
|
|
Service Code
|
HCPCS D3220
|
| Hospital Charge Code |
42300705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.62
|
| 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 |
$108.75
|
| 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
|
|
|
THERA PULSE II BED
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
40209309
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
THERAPY FOR CONTOUR DEFECTS
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
42201111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.34 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
THERAPY FOR CONTOUR DEFECTS >10CC
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
42201700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.64 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$726.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
THERAPY FOR USE OF SGD
|
Facility
OP
|
$315.98
|
|
|
Service Code
|
HCPCS 92609
|
| Hospital Charge Code |
41905003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$13,928.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.24
|
| Rate for Payer: Aetna Government |
$95.24
|
| Rate for Payer: Amida Care Medicaid |
$139.28
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,928.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.24
|
| Rate for Payer: Group Health Inc Commercial |
$157.99
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.28
|
| Rate for Payer: Healthfirst Essential Plan |
$313.38
|
| Rate for Payer: Healthfirst QHP |
$139.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.28
|
| Rate for Payer: SOMOS Essential |
$313.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$139.28
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
THERASKIN PER SQ CM
|
Facility
IP
|
$44.60
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
30305417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.30 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.30
|
|
|
THERASKIN PER SQ CM
|
Facility
OP
|
$44.60
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
30305417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$48.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.84
|
| Rate for Payer: Aetna Government |
$43.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.29
|
| Rate for Payer: Group Health Inc Commercial |
$22.30
|
| Rate for Payer: Group Health Inc Medicare |
$15.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.90
|
| Rate for Payer: SOMOS Essential |
$48.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.99
|
|
|
THERASKIN,PER SQ CM
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
42501058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$267.50 |
| Max. Negotiated Rate |
$267.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.50
|
|
|
THERASKIN,PER SQ CM
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
42501058
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.29 |
| Max. Negotiated Rate |
$347.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$294.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.84
|
| Rate for Payer: Aetna Government |
$43.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$267.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$307.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.29
|
| Rate for Payer: Group Health Inc Commercial |
$267.50
|
| Rate for Payer: Group Health Inc Medicare |
$187.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.90
|
| Rate for Payer: SOMOS Essential |
$48.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$347.75
|
|
|
THER/DIAG CONCURRENT INF
|
Facility
OP
|
$71.45
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
30305934
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Government |
$18.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.33
|
| Rate for Payer: Group Health Inc Commercial |
$35.72
|
| Rate for Payer: Group Health Inc Medicare |
$25.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.70
|
|
|
THER/DIAG CONCURRENT INF
|
Facility
OP
|
$71.45
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
30105934
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Government |
$18.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.33
|
| Rate for Payer: Group Health Inc Commercial |
$35.72
|
| Rate for Payer: Group Health Inc Medicare |
$25.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.70
|
|
|
THER FX NASAL INF TURBINATE.
|
Facility
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
40109383
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.34 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
THERICS PUTTY BN V FILLER 1CC
|
Facility
IP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
|
THERICS PUTTY BN V FILLER 1CC
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$287.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$325.00
|
|
|
THERIGRAFT PUTTY 5CC
|
Facility
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$920.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,680.00
|
| Rate for Payer: Group Health Inc Commercial |
$800.00
|
| Rate for Payer: Group Health Inc Medicare |
$560.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,040.00
|
|
|
THERIGRAFT PUTTY 5CC
|
Facility
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
|
|
THER INJECTION CARP TUNNEL
|
Facility
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
40009447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.38 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| Rate for Payer: Group Health Inc Commercial |
$342.51
|
| Rate for Payer: Group Health Inc Medicare |
$342.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
