|
TRACE ELEMENTS
|
Facility
OP
|
$49.99
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$32.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.74
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.49
|
|
|
TRACE ELEMENTS
|
Facility
IP
|
$49.99
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
TRACE ELEMENTS
|
Facility
IP
|
$49.99
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
TRACE ELEMENTS INJ
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41640713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
TRACE ELEMENTS INJ
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41650713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
TRACE ELEMENTS INJ PEDIATRIC
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
41643629
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
TRACE ELEMENTS INJ PEDIATRIC
|
Facility
OP
|
$7.00
|
|
| Hospital Charge Code |
41653629
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.76
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
TRACH, ADULT TIE 1 PC
|
Facility
OP
|
$2.82
|
|
| Hospital Charge Code |
64902296
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.41
|
| Rate for Payer: Aetna Government |
$1.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.92
|
| Rate for Payer: Group Health Inc Commercial |
$1.41
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.41
|
|
|
TRACHCARE
|
Facility
OP
|
$56.70
|
|
|
Service Code
|
HCPCS A4629
|
| Hospital Charge Code |
40307250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$59.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.82
|
| Rate for Payer: Aetna Government |
$2.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.54
|
| Rate for Payer: Group Health Inc Commercial |
$28.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.86
|
|
|
TRACHEOBRONCHOSCOPY
|
Facility
OP
|
$1,337.85
|
|
|
Service Code
|
HCPCS 31615
|
| Hospital Charge Code |
30304095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$636.27
|
| Rate for Payer: Aetna Government |
$636.27
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Cash Price |
$636.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$636.27
|
| 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 |
$636.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$540.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$636.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.28
|
| 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 |
$668.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$636.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$540.83
|
| Rate for Payer: Healthfirst QHP |
$636.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$636.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$636.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$636.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$509.02
|
| Rate for Payer: Wellcare Medicare |
$604.46
|
|
|
TRACHEOSTOMY
|
Facility
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
40108950
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$359.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| 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 |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$359.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
TRACHEOSTOMY
|
Facility
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 31600
|
| Hospital Charge Code |
40011070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.84 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| 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 |
$343.84
|
| 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 |
$382.05
|
| 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
|
|
|
TRACHEOSTOMY CRICOTHYROID MEMBRAN
|
Facility
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
30103271
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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: Elderplan Medicare Advantage |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$376.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
TRACHEOSTOMY, EMERG, CRICOTHYROID
|
Facility
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 31605
|
| Hospital Charge Code |
40019715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$225.98 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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: Elderplan Medicare Advantage |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$376.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| Rate for Payer: Group Health Inc Commercial |
$282.47
|
| Rate for Payer: Group Health Inc Medicare |
$282.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$417.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
IP
|
$69,160.62
|
|
|
Service Code
|
MS-DRG 012
|
| Min. Negotiated Rate |
$29,232.38 |
| Max. Negotiated Rate |
$69,160.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59,052.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62,865.33
|
| Rate for Payer: Aetna Government |
$62,865.33
|
| Rate for Payer: Brighton Health Commercial |
$58,071.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64,122.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$69,160.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57,074.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$59,722.06
|
| Rate for Payer: EmblemHealth Commercial |
$34,342.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$62,865.33
|
| Rate for Payer: Group Health Inc Commercial |
$62,865.33
|
| Rate for Payer: Group Health Inc Medicare |
$62,865.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62,865.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29,232.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62,865.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62,865.33
|
| Rate for Payer: Wellcare Medicare |
$59,722.06
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
IP
|
$89,044.14
|
|
|
Service Code
|
MS-DRG 011
|
| Min. Negotiated Rate |
$36,656.99 |
| Max. Negotiated Rate |
$89,044.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$76,029.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78,832.24
|
| Rate for Payer: Aetna Government |
$78,832.24
|
| Rate for Payer: Brighton Health Commercial |
$74,766.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80,408.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89,044.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73,483.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$74,890.63
|
| Rate for Payer: EmblemHealth Commercial |
$44,215.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$78,832.24
|
| Rate for Payer: Group Health Inc Commercial |
$78,832.24
|
| Rate for Payer: Group Health Inc Medicare |
$78,832.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78,832.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36,656.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78,832.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78,832.24
|
| Rate for Payer: Wellcare Medicare |
$74,890.63
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
IP
|
$46,379.35
|
|
|
Service Code
|
MS-DRG 013
|
| Min. Negotiated Rate |
$20,725.74 |
| Max. Negotiated Rate |
$46,379.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39,600.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44,571.48
|
| Rate for Payer: Aetna Government |
$44,571.48
|
| Rate for Payer: Brighton Health Commercial |
$38,942.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45,462.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46,379.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38,274.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$42,342.91
|
| Rate for Payer: EmblemHealth Commercial |
$23,029.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$44,571.48
|
| Rate for Payer: Group Health Inc Commercial |
$44,571.48
|
| Rate for Payer: Group Health Inc Medicare |
$44,571.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44,571.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20,725.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44,571.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44,571.48
|
| Rate for Payer: Wellcare Medicare |
$42,342.91
|
|
|
TRACHEOSTOMY/INCISION OF WINDPIPE
|
Facility
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 31600
|
| Hospital Charge Code |
30107833
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,723.23
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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 |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$343.84
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| 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 |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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
|
|
|
TRACHEOSTOMY TUBE CUFFED
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS A7521
|
| Hospital Charge Code |
64906229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.60
|
| Rate for Payer: Aetna Government |
$28.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.25
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.25
|
|
|
TRACHEOSTOMY TUBE CUFFED
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
HCPCS A7521
|
| Hospital Charge Code |
64906229
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
|
|
TRACHEOSTOMY TUBES
|
Facility
OP
|
$73.71
|
|
| Hospital Charge Code |
40000390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$58.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.86
|
| Rate for Payer: Aetna Government |
$36.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.12
|
| Rate for Payer: Group Health Inc Commercial |
$36.86
|
| Rate for Payer: Group Health Inc Medicare |
$25.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.86
|
|
|
TRACHEOSTOMY TUBES
|
Facility
OP
|
$6.03
|
|
| Hospital Charge Code |
40207634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$2.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
IP
|
$253,854.30
|
|
|
Service Code
|
MS-DRG 004
|
| Min. Negotiated Rate |
$98,197.95 |
| Max. Negotiated Rate |
$253,854.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216,751.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$211,178.38
|
| Rate for Payer: Aetna Government |
$211,178.38
|
| Rate for Payer: Brighton Health Commercial |
$213,150.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$215,401.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$253,854.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$209,491.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$200,619.46
|
| Rate for Payer: EmblemHealth Commercial |
$126,053.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$211,178.38
|
| Rate for Payer: Group Health Inc Commercial |
$211,178.38
|
| Rate for Payer: Group Health Inc Medicare |
$211,178.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211,178.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98,197.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$211,178.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211,178.38
|
| Rate for Payer: Wellcare Medicare |
$200,619.46
|
|
|
TRACHEOTOMY TRAY
|
Facility
OP
|
$45.36
|
|
| Hospital Charge Code |
40206045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$36.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.68
|
| Rate for Payer: Aetna Government |
$22.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.84
|
| Rate for Payer: Group Health Inc Commercial |
$22.68
|
| Rate for Payer: Group Health Inc Medicare |
$15.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.68
|
|
|
TRACHEOTOMY TUBE BRUSH
|
Facility
OP
|
$41.82
|
|
| Hospital Charge Code |
40206005
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$33.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.91
|
| Rate for Payer: Aetna Government |
$20.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.44
|
| Rate for Payer: Group Health Inc Commercial |
$20.91
|
| Rate for Payer: Group Health Inc Medicare |
$14.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.91
|
|
