|
TRANSFIXING PINS
|
Facility
OP
|
$214.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209863
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$74.90 |
| Max. Negotiated Rate |
$224.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$107.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$123.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.70
|
| Rate for Payer: Group Health Inc Commercial |
$107.00
|
| Rate for Payer: Group Health Inc Medicare |
$74.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.10
|
|
|
TRANSFUSION REACTION
|
Facility
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
40711160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.11 |
| Max. Negotiated Rate |
$239.05 |
| 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: 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 |
$54.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.09
|
| 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 CHP/FHP/Medicaid |
$55.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC
|
Facility
IP
|
$18,771.80
|
|
|
Service Code
|
MS-DRG 069
|
| Min. Negotiated Rate |
$6,848.85 |
| Max. Negotiated Rate |
$18,771.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,776.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,403.73
|
| Rate for Payer: Aetna Government |
$18,403.73
|
| Rate for Payer: Brighton Health Commercial |
$11,581.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,771.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,792.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,382.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,483.54
|
| Rate for Payer: EmblemHealth Commercial |
$6,848.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,403.73
|
| Rate for Payer: Group Health Inc Commercial |
$18,403.73
|
| Rate for Payer: Group Health Inc Medicare |
$18,403.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,403.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,557.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,403.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,403.73
|
| Rate for Payer: Wellcare Medicare |
$17,483.54
|
|
|
TRANSLUMIAL ARTHRECTOMY ILIAC
|
Facility
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 0238T
|
| Hospital Charge Code |
40039877
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$24,139.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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 |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
TRANSMETATARSAL AMPUTATN
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28820
|
| Hospital Charge Code |
40082760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
TRANSOSSEOUS IMPLANT
|
Facility
OP
|
$6,396.00
|
|
|
Service Code
|
HCPCS D6050
|
| Hospital Charge Code |
42301425
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,726.08 |
| Max. Negotiated Rate |
$3,517.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,517.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,726.08
|
| Rate for Payer: Aetna Government |
$1,726.08
|
| 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 |
$3,198.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,238.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,198.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,198.00
|
|
|
TRANSPARENT FILM DRESSING
|
Facility
OP
|
$9.04
|
|
|
Service Code
|
HCPCS A6258
|
| Hospital Charge Code |
41809570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$7.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.62
|
| Rate for Payer: Aetna Government |
$2.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.15
|
| Rate for Payer: Group Health Inc Commercial |
$4.52
|
| Rate for Payer: Group Health Inc Medicare |
$3.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.52
|
|
|
Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar (List separately in addition to code for primary procedure)
|
Facility
OP
|
$4,065.00
|
|
|
Service Code
|
CPT 63057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$387.24 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$396.51
|
| Rate for Payer: Aetna Government |
$396.51
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$387.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$430.27
|
|
|
Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc)
|
Facility
OP
|
$8,273.12
|
|
|
Service Code
|
CPT 63056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$8,273.12 |
| 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: 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 |
$1,792.80
|
| 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 Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,992.00
|
| 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
|
|
|
TRANSPLANT/GRAFT PALM TENDON
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26489
|
| Hospital Charge Code |
40029825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,102.97 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,102.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,225.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
TRANS ROD 110
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
|
|
TRANS ROD 110
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$609.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$319.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$290.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.00
|
| Rate for Payer: Group Health Inc Commercial |
$290.00
|
| Rate for Payer: Group Health Inc Medicare |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.00
|
|
|
TRANSSEPTAL FIBEROTOMY
|
Facility
OP
|
$262.00
|
|
|
Service Code
|
HCPCS D7291
|
| Hospital Charge Code |
42301730
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
TRANSUR ELECTR RESECT OF PROSTATE
|
Facility
OP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
40122970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$782.74 |
| Max. Negotiated Rate |
$6,408.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,983.74
|
| Rate for Payer: Aetna Government |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,983.74
|
| 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 |
$5,983.74
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$782.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,086.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,325.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,983.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,325.53
|
| Rate for Payer: Group Health Inc Commercial |
$5,983.74
|
| Rate for Payer: Group Health Inc Medicare |
$5,983.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,983.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$869.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,086.18
|
| Rate for Payer: Healthfirst QHP |
$5,983.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,983.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,983.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,786.99
|
| Rate for Payer: Wellcare Medicare |
$5,684.55
|
|
|
TRANSUR ELECTR RESECT OF PROSTATE
|
Facility
OP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 52601
|
| Hospital Charge Code |
40014289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$782.74 |
| Max. Negotiated Rate |
$6,408.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,983.74
|
| Rate for Payer: Aetna Government |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,983.74
|
| 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 |
$5,983.74
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$782.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,086.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,325.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,983.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,325.53
|
| Rate for Payer: Group Health Inc Commercial |
$5,983.74
|
| Rate for Payer: Group Health Inc Medicare |
$5,983.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,983.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$869.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,086.18
|
| Rate for Payer: Healthfirst QHP |
$5,983.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,983.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,983.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,786.99
|
| Rate for Payer: Wellcare Medicare |
$5,684.55
|
|
|
Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)
|
Facility
OP
|
$5,983.74
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$782.74 |
| Max. Negotiated Rate |
$5,983.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,983.74
|
| Rate for Payer: Aetna Government |
$5,983.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,983.74
|
| 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 |
$5,983.74
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$782.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,086.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,325.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,983.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,325.53
|
| Rate for Payer: Group Health Inc Commercial |
$5,983.74
|
| Rate for Payer: Group Health Inc Medicare |
$5,983.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,983.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$869.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,086.18
|
| Rate for Payer: Healthfirst QHP |
$5,983.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,983.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,983.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,786.99
|
| Rate for Payer: Wellcare Medicare |
$5,684.55
|
|
|
Transurethral incision of prostate
|
Facility
OP
|
$4,031.47
|
|
|
Service Code
|
CPT 52450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$511.98 |
| Max. Negotiated Rate |
$4,031.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| 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 |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$511.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$568.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
IP
|
$29,180.92
|
|
|
Service Code
|
MS-DRG 669
|
| Min. Negotiated Rate |
$13,159.20 |
| Max. Negotiated Rate |
$29,180.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,627.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,608.75
|
| Rate for Payer: Aetna Government |
$28,608.75
|
| Rate for Payer: Brighton Health Commercial |
$22,251.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,180.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,501.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,869.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,178.31
|
| Rate for Payer: EmblemHealth Commercial |
$13,159.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,608.75
|
| Rate for Payer: Group Health Inc Commercial |
$28,608.75
|
| Rate for Payer: Group Health Inc Medicare |
$28,608.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,608.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,303.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,608.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,608.75
|
| Rate for Payer: Wellcare Medicare |
$27,178.31
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
IP
|
$48,664.04
|
|
|
Service Code
|
MS-DRG 668
|
| Min. Negotiated Rate |
$21,578.85 |
| Max. Negotiated Rate |
$48,664.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41,551.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46,406.13
|
| Rate for Payer: Aetna Government |
$46,406.13
|
| Rate for Payer: Brighton Health Commercial |
$40,861.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47,334.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48,664.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40,159.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$44,085.82
|
| Rate for Payer: EmblemHealth Commercial |
$24,164.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$46,406.13
|
| Rate for Payer: Group Health Inc Commercial |
$46,406.13
|
| Rate for Payer: Group Health Inc Medicare |
$46,406.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46,406.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21,578.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46,406.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46,406.13
|
| Rate for Payer: Wellcare Medicare |
$44,085.82
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$21,090.12
|
|
|
Service Code
|
MS-DRG 670
|
| Min. Negotiated Rate |
$8,254.30 |
| Max. Negotiated Rate |
$21,090.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,193.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,676.59
|
| Rate for Payer: Aetna Government |
$20,676.59
|
| Rate for Payer: Brighton Health Commercial |
$13,957.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,090.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,623.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,718.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,642.76
|
| Rate for Payer: EmblemHealth Commercial |
$8,254.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,676.59
|
| Rate for Payer: Group Health Inc Commercial |
$20,676.59
|
| Rate for Payer: Group Health Inc Medicare |
$20,676.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,676.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,614.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,676.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,676.59
|
| Rate for Payer: Wellcare Medicare |
$19,642.76
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
IP
|
$27,994.16
|
|
|
Service Code
|
MS-DRG 713
|
| Min. Negotiated Rate |
$12,439.80 |
| Max. Negotiated Rate |
$27,994.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,390.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,445.25
|
| Rate for Payer: Aetna Government |
$27,445.25
|
| Rate for Payer: Brighton Health Commercial |
$21,035.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,994.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,052.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,674.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,072.99
|
| Rate for Payer: EmblemHealth Commercial |
$12,439.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,445.25
|
| Rate for Payer: Group Health Inc Commercial |
$27,445.25
|
| Rate for Payer: Group Health Inc Medicare |
$27,445.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,445.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,762.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,445.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,445.25
|
| Rate for Payer: Wellcare Medicare |
$26,072.99
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
IP
|
$21,032.12
|
|
|
Service Code
|
MS-DRG 714
|
| Min. Negotiated Rate |
$8,219.14 |
| Max. Negotiated Rate |
$21,032.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,133.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,619.73
|
| Rate for Payer: Aetna Government |
$20,619.73
|
| Rate for Payer: Brighton Health Commercial |
$13,898.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,032.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,552.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,659.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,588.74
|
| Rate for Payer: EmblemHealth Commercial |
$8,219.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,619.73
|
| Rate for Payer: Group Health Inc Commercial |
$20,619.73
|
| Rate for Payer: Group Health Inc Medicare |
$20,619.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,619.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,588.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,619.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,619.73
|
| Rate for Payer: Wellcare Medicare |
$19,588.74
|
|
|
TRANVAGINAL MID URETHRA SLING SYS
|
Facility
OP
|
$438.00
|
|
| Hospital Charge Code |
40205635
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$350.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$240.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$219.00
|
| Rate for Payer: Aetna Government |
$219.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$350.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$297.84
|
| Rate for Payer: Group Health Inc Commercial |
$219.00
|
| Rate for Payer: Group Health Inc Medicare |
$153.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$219.00
|
|
|
TRAPEXID RX 3.0CM
|
Facility
OP
|
$730.00
|
|
| Hospital Charge Code |
64905334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$584.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$401.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.00
|
| Rate for Payer: Aetna Government |
$365.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$584.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$496.40
|
| Rate for Payer: Group Health Inc Commercial |
$365.00
|
| Rate for Payer: Group Health Inc Medicare |
$255.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.00
|
|
|
TRAPEZOLO RX 2.0CM
|
Facility
OP
|
$730.28
|
|
| Hospital Charge Code |
64905332
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$584.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$401.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.14
|
| Rate for Payer: Aetna Government |
$365.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$584.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$496.59
|
| Rate for Payer: Group Health Inc Commercial |
$365.14
|
| Rate for Payer: Group Health Inc Medicare |
$255.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$365.14
|
|
