|
TOSEMIDE 100MG TAB
|
Facility
OP
|
$0.52
|
|
| Hospital Charge Code |
41656605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
TOTAL CARE SPORT BED
|
Facility
OP
|
$293.98
|
|
| Hospital Charge Code |
40208000
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.89 |
| Max. Negotiated Rate |
$235.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$161.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$146.99
|
| Rate for Payer: Aetna Government |
$146.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$235.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$199.91
|
| Rate for Payer: Group Health Inc Commercial |
$146.99
|
| Rate for Payer: Group Health Inc Medicare |
$102.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.99
|
|
|
TOTAL FIRST MPJ IMPLANT
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 26531
|
| Hospital Charge Code |
40082755
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$718.16 |
| Max. Negotiated Rate |
$9,058.92 |
| 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: 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 CHP/HARP/Medicaid |
$718.16
|
| 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 CHP/FHP/Medicaid |
$797.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TOTAL HEMOGLOBIN
|
Facility
OP
|
$5.93
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
40602660
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.37
|
| Rate for Payer: Aetna Government |
$2.37
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.37
|
| Rate for Payer: EmblemHealth Commercial |
$2.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.11
|
| Rate for Payer: Group Health Inc Commercial |
$2.37
|
| Rate for Payer: Group Health Inc Medicare |
$2.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.37
|
| Rate for Payer: Healthfirst QHP |
$2.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.90
|
| Rate for Payer: Wellcare Medicare |
$2.13
|
|
|
TOTAL HIP REPLACEMENT
|
Facility
OP
|
$36,044.28
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
40021675
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,457.38 |
| Max. Negotiated Rate |
$18,022.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,219.83
|
| Rate for Payer: Aetna Government |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15,219.83
|
| 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 |
$15,219.83
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,457.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12,936.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13,545.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,219.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13,545.65
|
| Rate for Payer: Group Health Inc Commercial |
$15,219.83
|
| Rate for Payer: Group Health Inc Medicare |
$15,219.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,022.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,219.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,619.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,936.86
|
| Rate for Payer: Healthfirst QHP |
$15,219.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,219.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,219.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,175.86
|
| Rate for Payer: Wellcare Medicare |
$14,458.84
|
|
|
TOTAL IRON BINDING CAPACITY
|
Facility
OP
|
$21.85
|
|
|
Service Code
|
HCPCS 83550
|
| Hospital Charge Code |
40602650
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.74
|
| Rate for Payer: Aetna Government |
$8.74
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.74
|
| Rate for Payer: EmblemHealth Commercial |
$8.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.78
|
| Rate for Payer: Group Health Inc Commercial |
$8.74
|
| Rate for Payer: Group Health Inc Medicare |
$8.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.74
|
| Rate for Payer: Healthfirst QHP |
$8.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.99
|
| Rate for Payer: Wellcare Medicare |
$7.87
|
|
|
TOTAL KNEE REPLACEMENT
|
Facility
OP
|
$36,044.28
|
|
|
Service Code
|
HCPCS 27447
|
| Hospital Charge Code |
40021700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,455.57 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,219.83
|
| Rate for Payer: Aetna Government |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15,219.83
|
| 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 |
$15,219.83
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,455.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12,936.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13,545.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,219.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13,545.65
|
| Rate for Payer: Group Health Inc Commercial |
$15,219.83
|
| Rate for Payer: Group Health Inc Medicare |
$15,219.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,022.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,219.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,617.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,936.86
|
| Rate for Payer: Healthfirst QHP |
$15,219.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,219.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,219.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,175.86
|
| Rate for Payer: Wellcare Medicare |
$14,458.84
|
|
|
TOTAL KNEE SYSTEM
|
Facility
OP
|
$5,297.91
|
|
| Hospital Charge Code |
40207010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,854.27 |
| Max. Negotiated Rate |
$4,238.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,913.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,648.96
|
| Rate for Payer: Aetna Government |
$2,648.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,238.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,602.58
|
| Rate for Payer: Group Health Inc Commercial |
$2,648.96
|
| Rate for Payer: Group Health Inc Medicare |
$1,854.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,648.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,648.96
|
|
|
TOTAL KNEE/TIBIAL
|
Facility
OP
|
$5,411.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,682.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,976.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,705.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,111.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,682.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,705.78
|
| Rate for Payer: Group Health Inc Medicare |
$1,894.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,705.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,705.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,517.51
|
|
|
TOTAL KNEE/TIBIAL
|
Facility
IP
|
$5,411.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203098
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,705.78 |
| Max. Negotiated Rate |
$2,705.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,705.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,705.78
|
|
|
TOTAL KNEE UNIV TIBI BSE PLTE SZ3
|
Facility
OP
|
$6,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,993.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,663.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,829.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,993.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,330.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,331.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,330.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,329.00
|
|
|
TOTAL KNEE UNIV TIBI BSE PLTE SZ3
|
Facility
IP
|
$6,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.00 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,330.00
|
|
|
TOTAL KNE UNIV TIBI BSE PLTSIZE4
|
Facility
OP
|
$6,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,993.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,663.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,829.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,993.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,330.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,331.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,330.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,329.00
|
|
|
TOTAL KNE UNIV TIBI BSE PLTSIZE4
|
Facility
IP
|
$6,660.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200323
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,330.00 |
| Max. Negotiated Rate |
$3,330.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,330.00
|
|
|
TOTAL SHOULDER SYSTEM
|
Facility
OP
|
$3,820.52
|
|
| Hospital Charge Code |
40207012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,337.18 |
| Max. Negotiated Rate |
$3,056.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,101.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,910.26
|
| Rate for Payer: Aetna Government |
$1,910.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,056.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,597.95
|
| Rate for Payer: Group Health Inc Commercial |
$1,910.26
|
| Rate for Payer: Group Health Inc Medicare |
$1,337.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,910.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,910.26
|
|
|
Total thyroid lobectomy, unilateral; with or without isthmusectomy
|
Facility
OP
|
$6,672.53
|
|
|
Service Code
|
CPT 60220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$800.20 |
| Max. Negotiated Rate |
$6,672.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$800.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$889.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
TOUCH PREP DURING F/S PROCEDURE
|
Facility
OP
|
$1,902.65
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
40635403
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$33.45 |
| Max. Negotiated Rate |
$1,046.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,046.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$994.39
|
| Rate for Payer: Aetna Government |
$994.39
|
| Rate for Payer: Brighton Health Commercial |
$994.39
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$994.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$994.39
|
| Rate for Payer: EmblemHealth Commercial |
$994.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$885.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$994.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$885.01
|
| Rate for Payer: Group Health Inc Commercial |
$994.39
|
| Rate for Payer: Group Health Inc Medicare |
$994.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$951.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$994.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$994.39
|
| Rate for Payer: Healthfirst QHP |
$994.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$994.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$994.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$795.51
|
| Rate for Payer: Wellcare Medicare |
$894.95
|
|
|
TOUCH PUMP
|
Facility
OP
|
$10,450.00
|
|
| Hospital Charge Code |
64906033
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,657.50 |
| Max. Negotiated Rate |
$8,360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,747.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,225.00
|
| Rate for Payer: Aetna Government |
$5,225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,106.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,225.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,657.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,225.00
|
|
|
TOURNIQUET BLUE
|
Facility
OP
|
$0.29
|
|
| Hospital Charge Code |
64901850
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
|
|
TOWEL DRAPE POLYLINED
|
Facility
OP
|
$0.36
|
|
| Hospital Charge Code |
40209470
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
|
|
TOWEL, O.R., STANDARD
|
Facility
OP
|
$1.12
|
|
| Hospital Charge Code |
64901266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.56
|
| Rate for Payer: Aetna Government |
$0.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.76
|
| Rate for Payer: Group Health Inc Commercial |
$0.56
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
|
|
TOXOPLASMA AB IGG, CSF
|
Facility
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
40619181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
TOXOPLASMA AB IGG, W/IGM
|
Facility
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
40608069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
TOXOPLASMA GONDII AB,IGM,QN
|
Facility
OP
|
$36.03
|
|
|
Service Code
|
HCPCS 86778
|
| Hospital Charge Code |
40619183
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.41
|
| Rate for Payer: Aetna Government |
$14.41
|
| Rate for Payer: Cash Price |
$14.41
|
| Rate for Payer: Cash Price |
$14.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.41
|
| Rate for Payer: EmblemHealth Commercial |
$14.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.82
|
| Rate for Payer: Group Health Inc Commercial |
$14.41
|
| Rate for Payer: Group Health Inc Medicare |
$14.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.41
|
| Rate for Payer: Healthfirst QHP |
$14.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Wellcare Medicare |
$12.97
|
|
|
TOXOPLASMA IGG,REFLEX IGM
|
Facility
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86777
|
| Hospital Charge Code |
40619180
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
