|
AUTGRFT IMPLNT KNEE W/SCOOP
|
Facility
|
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29866
|
| Hospital Charge Code |
40029428
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,588.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,588.37
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
AUTGRFT IMPLNT KNEE W/SCOOP
|
Facility
|
IP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29866
|
| Hospital Charge Code |
40029428
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
AUTO/DIR BLOOD PROCESSING FEE
|
Facility
|
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
40701190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$325.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$138.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$138.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$138.26
|
| Rate for Payer: Brighton Health Commercial |
$325.97
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Humana Medicare |
$201.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: United Healthcare Commercial |
$13.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
AUTO/DIR BLOOD PROCESSING FEE
|
Facility
|
IP
|
$434.63
|
|
|
Service Code
|
HCPCS 86920
|
| Hospital Charge Code |
40701190
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$197.52
|
|
|
AUTO/DIR BLOOD SURCHARGE
|
Facility
|
OP
|
$287.05
|
|
| Hospital Charge Code |
40701066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.47 |
| Max. Negotiated Rate |
$229.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$157.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$143.52
|
| Rate for Payer: Aetna Government |
$143.52
|
| Rate for Payer: Brighton Health Commercial |
$215.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$229.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.19
|
| Rate for Payer: Group Health Inc Commercial |
$143.52
|
| Rate for Payer: Group Health Inc Medicare |
$100.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.52
|
|
|
AUTOINJECTOR
|
Facility
|
OP
|
$625.00
|
|
| Hospital Charge Code |
64905938
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.50
|
| Rate for Payer: Aetna Government |
$312.50
|
| Rate for Payer: Brighton Health Commercial |
$468.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$425.00
|
| Rate for Payer: Group Health Inc Commercial |
$312.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.50
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
|
IP
|
$127,856.70
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$43,238.81 |
| Max. Negotiated Rate |
$127,856.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91,079.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$92,986.69
|
| Rate for Payer: Aetna Government |
$92,986.69
|
| Rate for Payer: Brighton Health Commercial |
$89,566.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94,846.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106,670.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88,029.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$88,337.36
|
| Rate for Payer: EmblemHealth Commercial |
$52,967.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$92,986.69
|
| Rate for Payer: Group Health Inc Commercial |
$92,986.69
|
| Rate for Payer: Group Health Inc Medicare |
$92,986.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92,986.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43,238.81
|
| Rate for Payer: Humana Medicare |
$127,856.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92,986.69
|
| Rate for Payer: United Healthcare Commercial |
$122,842.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92,986.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92,986.69
|
| Rate for Payer: Wellcare Medicare |
$88,337.36
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$127,856.70
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$43,238.81 |
| Max. Negotiated Rate |
$127,856.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91,079.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$92,986.69
|
| Rate for Payer: Aetna Government |
$92,986.69
|
| Rate for Payer: Brighton Health Commercial |
$89,566.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94,846.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106,670.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88,029.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$88,337.36
|
| Rate for Payer: EmblemHealth Commercial |
$52,967.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$92,986.69
|
| Rate for Payer: Group Health Inc Commercial |
$92,986.69
|
| Rate for Payer: Group Health Inc Medicare |
$92,986.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92,986.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43,238.81
|
| Rate for Payer: Humana Medicare |
$127,856.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92,986.69
|
| Rate for Payer: United Healthcare Commercial |
$122,842.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92,986.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92,986.69
|
| Rate for Payer: Wellcare Medicare |
$88,337.36
|
|
|
AUTOMATED RBC COUNT
|
Facility
|
IP
|
$7.55
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
30305607
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$3.02
|
|
|
AUTOMATED RBC COUNT
|
Facility
|
OP
|
$7.55
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
40629618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$5.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.11
|
| Rate for Payer: Brighton Health Commercial |
$5.66
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.02
|
| Rate for Payer: EmblemHealth Commercial |
$3.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.69
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.02
|
| Rate for Payer: Healthfirst QHP |
$3.02
|
| Rate for Payer: Humana Medicare |
$3.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.02
|
| Rate for Payer: United Healthcare Commercial |
$3.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.42
|
| Rate for Payer: Wellcare Medicare |
$2.72
|
|
|
AUTOMATED RBC COUNT
|
Facility
|
OP
|
$7.55
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
30305607
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$5.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.11
|
| Rate for Payer: Brighton Health Commercial |
$5.66
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.02
|
| Rate for Payer: EmblemHealth Commercial |
$3.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.69
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.02
|
| Rate for Payer: Healthfirst QHP |
$3.02
|
| Rate for Payer: Humana Medicare |
$3.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.02
|
| Rate for Payer: United Healthcare Commercial |
$3.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.42
|
| Rate for Payer: Wellcare Medicare |
$2.72
|
|
|
AUTOMATED RBC COUNT
|
Facility
|
IP
|
$7.55
|
|
|
Service Code
|
HCPCS 85041
|
| Hospital Charge Code |
40629618
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$3.02
|
|
|
AUTOPSY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 88000
|
| Hospital Charge Code |
40635414
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$148.15 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$825.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$148.15
|
| Rate for Payer: Aetna Government |
$148.15
|
| Rate for Payer: Brighton Health Commercial |
$1,125.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$219.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$185.74
|
| Rate for Payer: Group Health Inc Commercial |
$750.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.00
|
|
|
AUTOSUTURE ENDO CLIP LG
|
Facility
|
OP
|
$1,105.54
|
|
| Hospital Charge Code |
40205113
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$386.94 |
| Max. Negotiated Rate |
$884.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$608.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$552.77
|
| Rate for Payer: Aetna Government |
$552.77
|
| Rate for Payer: Brighton Health Commercial |
$829.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$884.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$751.77
|
| Rate for Payer: Group Health Inc Commercial |
$552.77
|
| Rate for Payer: Group Health Inc Medicare |
$386.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$552.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$552.77
|
|
|
AUTO SUTURE (GIA50)
|
Facility
|
OP
|
$256.92
|
|
| Hospital Charge Code |
40202210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.92 |
| Max. Negotiated Rate |
$205.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$141.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$128.46
|
| Rate for Payer: Aetna Government |
$128.46
|
| Rate for Payer: Brighton Health Commercial |
$192.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$205.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$174.71
|
| Rate for Payer: Group Health Inc Commercial |
$128.46
|
| Rate for Payer: Group Health Inc Medicare |
$89.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.46
|
|
|
AUTO SUTURE (TA30)
|
Facility
|
OP
|
$3.75
|
|
| Hospital Charge Code |
40202222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.88
|
| Rate for Payer: Aetna Government |
$1.88
|
| Rate for Payer: Brighton Health Commercial |
$2.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.88
|
| Rate for Payer: Group Health Inc Medicare |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.88
|
|
|
AUTO TISSUE GRAFT ADDL TOOTH
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS D4283
|
| Hospital Charge Code |
42303464
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$687.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$526.58
|
| Rate for Payer: Aetna Government |
$526.58
|
| Rate for Payer: Brighton Health Commercial |
$937.50
|
| 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 |
$625.00
|
| Rate for Payer: Group Health Inc Medicare |
$437.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.00
|
|
|
AUTOVALVE QUICK ABVISER
|
Facility
|
OP
|
$229.48
|
|
| Hospital Charge Code |
64902814
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.32 |
| Max. Negotiated Rate |
$183.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.74
|
| Rate for Payer: Aetna Government |
$114.74
|
| Rate for Payer: Brighton Health Commercial |
$172.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.05
|
| Rate for Payer: Group Health Inc Commercial |
$114.74
|
| Rate for Payer: Group Health Inc Medicare |
$80.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.74
|
|
|
AVELUMAB 200 MG/10ML IV SOLN [137797]
|
Facility
|
IP
|
$225.56
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
44087353501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.78 |
| Max. Negotiated Rate |
$112.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.78
|
|
|
AVELUMAB 200 MG/10ML IV SOLN [137797]
|
Facility
|
OP
|
$225.56
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
44087353501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$146.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$92.37
|
| Rate for Payer: Aetna Government |
$92.37
|
| Rate for Payer: Brighton Health Commercial |
$135.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$92.37
|
| Rate for Payer: EmblemHealth Commercial |
$112.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.37
|
| Rate for Payer: Group Health Inc Commercial |
$92.37
|
| Rate for Payer: Group Health Inc Medicare |
$92.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.51
|
| Rate for Payer: Healthfirst QHP |
$92.37
|
| Rate for Payer: Humana Medicare |
$94.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$73.90
|
|
|
AVENIR MULLER STANDARD STEM 3
|
Facility
|
IP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,992.00 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
|
|
AVENIR MULLER STANDARD STEM 3
|
Facility
|
OP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$14,683.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,691.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$8,390.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,040.80
|
| Rate for Payer: EmblemHealth Commercial |
$6,992.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,683.20
|
| Rate for Payer: Group Health Inc Commercial |
$6,992.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,894.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,089.60
|
|
|
AVENIR MULLER STANDARD STEM 3
|
Facility
|
IP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,992.00 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
|
|
AVENIR MULLER STANDARD STEM 3
|
Facility
|
OP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$14,683.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,691.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$8,390.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,040.80
|
| Rate for Payer: EmblemHealth Commercial |
$6,992.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,683.20
|
| Rate for Payer: Group Health Inc Commercial |
$6,992.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,894.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,089.60
|
|
|
AVENIR MULLER STRD STEM 2
|
Facility
|
OP
|
$11,670.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$12,253.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,418.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$7,002.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,835.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,710.25
|
| Rate for Payer: EmblemHealth Commercial |
$5,835.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,253.50
|
| Rate for Payer: Group Health Inc Commercial |
$5,835.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,084.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,835.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,585.50
|
|
