|
REMOVL FORGN BODY -EAR W/O ANESTH
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
30102462
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
REMOVL FORGN BODY -EAR W/O ANESTH
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
40109215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| 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 |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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
|
|
|
REMOVL FORGN BODY -EAR W/O ANESTH
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
40109215
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
REMOVL FORGN BODY -EAR W/O ANESTH
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
30102462
|
|
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
|
|
|
REMOVL FROGN BODY -EAR W GEN ANES
|
Facility
|
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
40109216
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,312.42 |
| Max. Negotiated Rate |
$3,117.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Brighton Health Commercial |
$3,117.94
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
REMOVL FROGN BODY -EAR W GEN ANES
|
Facility
|
IP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
40109216
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,874.89
|
|
|
REM REACTION-PROD FOREIGN BODIES-
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
HCPCS D7540
|
| Hospital Charge Code |
42301845
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
REM REACTION-PROD FOREIGN BODIES-
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
HCPCS D7540
|
| Hospital Charge Code |
42301845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$584.65
|
| 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 |
$797.25
|
| 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 |
$531.50
|
| 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/REP CVD GEN DUAL LEADS
|
Facility
|
IP
|
$68,791.68
|
|
|
Service Code
|
HCPCS 33263
|
| Hospital Charge Code |
66520284
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$27,258.51
|
|
|
REM/REP CVD GEN DUAL LEADS
|
Facility
|
OP
|
$68,791.68
|
|
|
Service Code
|
HCPCS 33263
|
| Hospital Charge Code |
66520284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$51,593.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,258.51
|
| Rate for Payer: Aetna Government |
$27,258.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19,080.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19,080.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,080.96
|
| Rate for Payer: Brighton Health Commercial |
$51,593.76
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,258.51
|
| 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 |
$27,258.51
|
| Rate for Payer: EmblemHealth Commercial |
$27,258.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23,169.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24,260.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,258.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,260.07
|
| Rate for Payer: Group Health Inc Commercial |
$27,258.51
|
| Rate for Payer: Group Health Inc Medicare |
$27,258.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,395.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,258.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,169.73
|
| Rate for Payer: Healthfirst QHP |
$27,258.51
|
| Rate for Payer: Humana Medicare |
$27,803.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,258.51
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,258.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,258.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,806.81
|
| Rate for Payer: Wellcare Medicare |
$25,895.58
|
|
|
REM/REP CVD GEN SINGLE LEAD
|
Facility
|
OP
|
$68,791.68
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
66520283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$51,593.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,258.51
|
| Rate for Payer: Aetna Government |
$27,258.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19,080.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19,080.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,080.96
|
| Rate for Payer: Brighton Health Commercial |
$51,593.76
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,258.51
|
| 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 |
$27,258.51
|
| Rate for Payer: EmblemHealth Commercial |
$27,258.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23,169.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24,260.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,258.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,260.07
|
| Rate for Payer: Group Health Inc Commercial |
$27,258.51
|
| Rate for Payer: Group Health Inc Medicare |
$27,258.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,395.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,258.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,169.73
|
| Rate for Payer: Healthfirst QHP |
$27,258.51
|
| Rate for Payer: Humana Medicare |
$27,803.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,258.51
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,258.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,258.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,806.81
|
| Rate for Payer: Wellcare Medicare |
$25,895.58
|
|
|
REM/REP CVD GEN SINGLE LEAD
|
Facility
|
IP
|
$68,791.68
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
66520283
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$27,258.51
|
|
|
REM/REP PM GEN DUAL LEADS
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
66520281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$22,557.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| Rate for Payer: Aetna Government |
$12,348.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,644.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,644.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,644.01
|
| Rate for Payer: Brighton Health Commercial |
$22,557.00
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,348.58
|
| 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 |
$12,348.58
|
| Rate for Payer: EmblemHealth Commercial |
$12,348.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,496.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,990.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,348.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,990.24
|
| Rate for Payer: Group Health Inc Commercial |
$12,348.58
|
| Rate for Payer: Group Health Inc Medicare |
$12,348.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,038.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,496.29
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Humana Medicare |
$12,595.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,348.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,348.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,878.86
|
| Rate for Payer: Wellcare Medicare |
$11,731.15
|
|
|
REM/REP PM GEN DUAL LEADS
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
66520281
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
REM/REP PM GEN SINGLE LEAD
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
66520280
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
REM/REP PM GEN SINGLE LEAD
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
66520280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$17,358.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,824.59
|
| Rate for Payer: Aetna Government |
$9,824.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,877.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,877.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,877.21
|
| Rate for Payer: Brighton Health Commercial |
$17,358.94
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,824.59
|
| 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 |
$9,824.59
|
| Rate for Payer: EmblemHealth Commercial |
$9,824.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,350.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,743.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,824.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,743.89
|
| Rate for Payer: Group Health Inc Commercial |
$9,824.59
|
| Rate for Payer: Group Health Inc Medicare |
$9,824.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,824.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,350.90
|
| Rate for Payer: Healthfirst QHP |
$9,824.59
|
| Rate for Payer: Humana Medicare |
$10,021.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,824.59
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,824.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,824.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,859.67
|
| Rate for Payer: Wellcare Medicare |
$9,333.36
|
|
|
Renal biopsy; percutaneous, by trocar or needle
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 50200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
Renal biopsy; percutaneous, by trocar or needle
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 50200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,312.42 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
RENAL EXPLORTN, NEPHROSTOMY
|
Facility
|
OP
|
$3,102.59
|
|
|
Service Code
|
HCPCS 50045
|
| Hospital Charge Code |
40123035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,085.91 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,706.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,184.03
|
| Rate for Payer: Aetna Government |
$1,184.03
|
| Rate for Payer: Brighton Health Commercial |
$2,326.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,551.30
|
| Rate for Payer: Group Health Inc Medicare |
$1,085.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,551.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,551.30
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
RENAL FAILURE WITH CC
|
Facility
|
IP
|
$27,251.91
|
|
|
Service Code
|
MSDRG 683
|
| Min. Negotiated Rate |
$7,724.36 |
| Max. Negotiated Rate |
$27,251.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,282.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,819.57
|
| Rate for Payer: Aetna Government |
$19,819.57
|
| Rate for Payer: Brighton Health Commercial |
$13,061.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,215.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,555.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,837.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,828.59
|
| Rate for Payer: EmblemHealth Commercial |
$7,724.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,819.57
|
| Rate for Payer: Group Health Inc Commercial |
$19,819.57
|
| Rate for Payer: Group Health Inc Medicare |
$19,819.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,819.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,216.10
|
| Rate for Payer: Humana Medicare |
$27,251.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,819.57
|
| Rate for Payer: United Healthcare Commercial |
$17,914.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,819.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,819.57
|
| Rate for Payer: Wellcare Medicare |
$18,828.59
|
|
|
RENAL FAILURE WITH MCC
|
Facility
|
IP
|
$38,692.51
|
|
|
Service Code
|
MSDRG 682
|
| Min. Negotiated Rate |
$12,869.40 |
| Max. Negotiated Rate |
$38,692.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,129.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,140.01
|
| Rate for Payer: Aetna Government |
$28,140.01
|
| Rate for Payer: Brighton Health Commercial |
$21,761.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,702.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,917.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,388.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,733.01
|
| Rate for Payer: EmblemHealth Commercial |
$12,869.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,140.01
|
| Rate for Payer: Group Health Inc Commercial |
$28,140.01
|
| Rate for Payer: Group Health Inc Medicare |
$28,140.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,140.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,085.10
|
| Rate for Payer: Humana Medicare |
$38,692.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,140.01
|
| Rate for Payer: United Healthcare Commercial |
$29,846.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,140.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,140.01
|
| Rate for Payer: Wellcare Medicare |
$26,733.01
|
|
|
RENAL FAILURE WITHOUT CC/MCC
|
Facility
|
IP
|
$21,678.46
|
|
|
Service Code
|
MSDRG 684
|
| Min. Negotiated Rate |
$5,217.89 |
| Max. Negotiated Rate |
$21,678.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,972.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,766.15
|
| Rate for Payer: Aetna Government |
$15,766.15
|
| Rate for Payer: Brighton Health Commercial |
$8,823.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,081.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10,508.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,671.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$14,977.84
|
| Rate for Payer: EmblemHealth Commercial |
$5,217.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,766.15
|
| Rate for Payer: Group Health Inc Commercial |
$15,766.15
|
| Rate for Payer: Group Health Inc Medicare |
$15,766.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,766.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,331.26
|
| Rate for Payer: Humana Medicare |
$21,678.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,766.15
|
| Rate for Payer: United Healthcare Commercial |
$12,101.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,766.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,766.15
|
| Rate for Payer: Wellcare Medicare |
$14,977.84
|
|
|
RENAL SET
|
Facility
|
OP
|
$5.67
|
|
| Hospital Charge Code |
40205410
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.84
|
| Rate for Payer: Aetna Government |
$2.84
|
| Rate for Payer: Brighton Health Commercial |
$4.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.86
|
| Rate for Payer: Group Health Inc Commercial |
$2.84
|
| Rate for Payer: Group Health Inc Medicare |
$1.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.84
|
|
|
RENIN ACTIVITY, PLASMA
|
Facility
|
IP
|
$54.98
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
40609114
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$21.99
|
|
|
RENIN ACTIVITY, PLASMA
|
Facility
|
OP
|
$54.98
|
|
|
Service Code
|
HCPCS 84244
|
| Hospital Charge Code |
40609114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$41.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.99
|
| Rate for Payer: Aetna Government |
$21.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.39
|
| Rate for Payer: Brighton Health Commercial |
$41.24
|
| Rate for Payer: Cash Price |
$21.99
|
| Rate for Payer: Cash Price |
$21.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.99
|
| Rate for Payer: EmblemHealth Commercial |
$21.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.57
|
| Rate for Payer: Group Health Inc Commercial |
$21.99
|
| Rate for Payer: Group Health Inc Medicare |
$21.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.99
|
| Rate for Payer: Healthfirst QHP |
$21.99
|
| Rate for Payer: Humana Medicare |
$22.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.99
|
| Rate for Payer: United Healthcare Commercial |
$27.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.59
|
| Rate for Payer: Wellcare Medicare |
$19.79
|
|
