|
BONE GRAFT TIME OF IMPL PLACEMT
|
Facility
OP
|
$625.00
|
|
|
Service Code
|
HCPCS D6104
|
| Hospital Charge Code |
42300743
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$219.91
|
| Rate for Payer: Aetna Government |
$219.91
|
| 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 |
$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
|
|
|
BONE GRAFT TX ORBIT
|
Facility
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 21408
|
| Hospital Charge Code |
40013262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,015.88 |
| Max. Negotiated Rate |
$7,345.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,015.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,128.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
BONE GROWTH STIMULATOR
|
Facility
IP
|
$23,285.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,642.50 |
| Max. Negotiated Rate |
$11,642.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,642.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,642.50
|
|
|
BONE GROWTH STIMULATOR
|
Facility
OP
|
$23,285.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904357
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$24,449.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,806.75
|
| 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 |
$11,642.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,388.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,449.25
|
| Rate for Payer: Group Health Inc Commercial |
$11,642.50
|
| Rate for Payer: Group Health Inc Medicare |
$8,149.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,642.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,642.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,135.25
|
|
|
BONE HOOK
|
Facility
IP
|
$416.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.00
|
|
|
BONE HOOK
|
Facility
OP
|
$416.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$228.80
|
| 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 |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$239.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$436.80
|
| Rate for Payer: Group Health Inc Commercial |
$208.00
|
| Rate for Payer: Group Health Inc Medicare |
$145.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$270.40
|
|
|
BONE/JOINT DISLOC. BELOW W/ANESTH
|
Facility
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
30103040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,858.61
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$548.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| 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 |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
BONE/JOINT DISLOC. SHOULDER W/ANE
|
Facility
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,858.61
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| 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 |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
BONE MAROW TRAY STERNAL PUNC.
|
Facility
OP
|
$65.21
|
|
| Hospital Charge Code |
40200650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.60
|
| Rate for Payer: Aetna Government |
$32.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.34
|
| Rate for Payer: Group Health Inc Commercial |
$32.60
|
| Rate for Payer: Group Health Inc Medicare |
$22.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.60
|
|
|
Bone Marrow
|
Facility
OP
|
$194.55
|
|
| Hospital Charge Code |
40200645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$68.09 |
| Max. Negotiated Rate |
$155.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$107.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$97.28
|
| Rate for Payer: Aetna Government |
$97.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.29
|
| Rate for Payer: Group Health Inc Commercial |
$97.28
|
| Rate for Payer: Group Health Inc Medicare |
$68.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.28
|
|
|
BONE MARROW ASP
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
40509888
|
|
Hospital Revenue Code
|
369
|
| Min. Negotiated Rate |
$71.56 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
BONE MARROW ASPIRATION
|
Facility
OP
|
$2,017.24
|
|
|
Service Code
|
HCPCS 85097
|
| Hospital Charge Code |
40635422
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.82 |
| Max. Negotiated Rate |
$9,792.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,109.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$994.39
|
| Rate for Payer: Aetna Government |
$994.39
|
| Rate for Payer: Amida Care Medicaid |
$97.92
|
| 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 |
$52.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$994.39
|
| Rate for Payer: EmblemHealth Commercial |
$994.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9,792.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$994.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.82
|
| 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 |
$97.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$994.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.92
|
| Rate for Payer: Healthfirst Essential Plan |
$220.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$994.39
|
| Rate for Payer: Healthfirst QHP |
$97.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$994.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.92
|
| Rate for Payer: SOMOS Essential |
$220.32
|
| 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
|
|
|
BONE MARROW ASPIRATION
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
40019860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$71.56 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
BONE MARROW ASP (MCR)
|
Facility
OP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
40509887
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| 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 |
$3,285.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| 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 |
$3,511.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,793.07
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,285.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
BONE MARROW ASP (MCR)
|
Facility
OP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
30306409
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| 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 |
$3,285.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| 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 |
$3,511.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,793.07
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,285.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
BONE MARROW BIOPSY
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
30305682
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
BONE MARROW BIOPSY
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
40019859
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
BONE MARROW BX
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
40509886
|
|
Hospital Revenue Code
|
369
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
BONE MARROW CONCENTRATE
|
Facility
IP
|
$6,737.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.75 |
| Max. Negotiated Rate |
$3,368.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,368.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,368.75
|
|
|
BONE MARROW CONCENTRATE
|
Facility
OP
|
$6,737.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$7,074.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,705.62
|
| 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 |
$3,368.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,874.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,074.38
|
| Rate for Payer: Group Health Inc Commercial |
$3,368.75
|
| Rate for Payer: Group Health Inc Medicare |
$2,358.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,368.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,368.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,379.38
|
|
|
BONE MARROW DISP NDLE
|
Facility
OP
|
$63.43
|
|
| Hospital Charge Code |
40200651
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.72
|
| Rate for Payer: Aetna Government |
$31.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.13
|
| Rate for Payer: Group Health Inc Commercial |
$31.72
|
| Rate for Payer: Group Health Inc Medicare |
$22.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.72
|
|
|
BONE MARROW TRAY
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
HCPCS A4550
|
| Hospital Charge Code |
40509889
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.57
|
| Rate for Payer: Aetna Government |
$13.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
BONE MICRO MORSEL 10CC SYN CAN
|
Facility
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.00
|
|
|
BONE MICRO MORSEL 10CC SYN CAN
|
Facility
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$825.00
|
| 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 |
$750.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$862.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,575.00
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$975.00
|
|
|
BONE PLATE #7 VITALLIUM
|
Facility
OP
|
$36.86
|
|
| Hospital Charge Code |
40200654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$29.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.43
|
| Rate for Payer: Aetna Government |
$18.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.06
|
| Rate for Payer: Group Health Inc Commercial |
$18.43
|
| Rate for Payer: Group Health Inc Medicare |
$12.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.43
|
|
