|
BOWEL RESECTION
|
Facility
OP
|
$4,205.72
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
40010635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,472.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,313.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,646.66
|
| Rate for Payer: Aetna Government |
$1,646.66
|
| 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 |
$1,597.79
|
| Rate for Payer: Group Health Inc Commercial |
$2,102.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,472.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,102.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,102.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,775.32
|
|
|
BOWL MIX CEMNT ADV CARTRDGE 180GR
|
Facility
OP
|
$1,912.50
|
|
| Hospital Charge Code |
64904270
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$669.38 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,051.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$956.25
|
| Rate for Payer: Aetna Government |
$956.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,530.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,300.50
|
| Rate for Payer: Group Health Inc Commercial |
$956.25
|
| Rate for Payer: Group Health Inc Medicare |
$669.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$956.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$956.25
|
|
|
BOWL QUIK-VAC CEMENT MIXING
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| 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 |
$65.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.50
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|
|
BOWL QUIK-VAC CEMENT MIXING
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205059
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
|
|
BOWL QUIK-VAC CEMENT MIXING
|
Facility
OP
|
$160.80
|
|
| Hospital Charge Code |
64904432
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.28 |
| Max. Negotiated Rate |
$128.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.40
|
| Rate for Payer: Aetna Government |
$80.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$128.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$109.34
|
| Rate for Payer: Group Health Inc Commercial |
$80.40
|
| Rate for Payer: Group Health Inc Medicare |
$56.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.40
|
|
|
BOWL,STERILE,MEDIUM
|
Facility
OP
|
$1.56
|
|
| Hospital Charge Code |
64901736
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.78
|
|
|
BOX RTS BASIC COMPLETE MEMORY
|
Facility
OP
|
$77.90
|
|
| Hospital Charge Code |
64903115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$62.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.95
|
| Rate for Payer: Aetna Government |
$38.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52.97
|
| Rate for Payer: Group Health Inc Commercial |
$38.95
|
| Rate for Payer: Group Health Inc Medicare |
$27.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.95
|
|
|
B PERTUSSIS, NASOPHAR CULTURE
|
Facility
OP
|
$21.55
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
40619185
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$13.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.90
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
BRACELET ALLERGY (YELLOW)
|
Facility
OP
|
$0.21
|
|
| Hospital Charge Code |
64901153
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
|
|
BRACELET ID INFANT 4PART
|
Facility
OP
|
$0.47
|
|
| Hospital Charge Code |
64903234
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.32
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
|
|
BRACHIAL PLEXUS,CONT INFUS
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64416
|
| Hospital Charge Code |
30305027
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
BRACHIAL PLEXUS, SINGLE
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64415
|
| Hospital Charge Code |
30305026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
BRACHY ISODOSE COMPI
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77318 TC
|
| Hospital Charge Code |
66542938
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.13
|
|
|
BRACHY ISODOS PLAN INTER
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77317 TC
|
| Hospital Charge Code |
66542937
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.05 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.05
|
|
|
BRACHYTX ISODOSE COMPLEX
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77318 TC
|
| Hospital Charge Code |
66541268
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.13
|
|
|
BRACHYTX ISODOSE INTERMED
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77317 TC
|
| Hospital Charge Code |
66541267
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.05 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$279.05
|
|
|
BRACHYTX ISODOSE PLAN SIMP
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77316 TC
|
| Hospital Charge Code |
66542936
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$211.36 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.36
|
|
|
BRACHYTX ISODOSE PLAN SIMPLE
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77316 TC
|
| Hospital Charge Code |
66541266
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$211.36 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.36
|
|
|
BRAIN BIOPSY
|
Facility
OP
|
$3,710.78
|
|
|
Service Code
|
HCPCS 61140
|
| Hospital Charge Code |
40000510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.77 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,040.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,597.52
|
| Rate for Payer: Aetna Government |
$1,597.52
|
| 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 |
$1,569.28
|
| Rate for Payer: Group Health Inc Commercial |
$1,855.39
|
| Rate for Payer: Group Health Inc Medicare |
$1,298.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,855.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,855.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,743.65
|
|
|
BRAIN CANAL SHUNT PROCEDURE
|
Facility
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 61070
|
| Hospital Charge Code |
30300184
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| 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 |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
BRA MEDEBRA WHT 3X 46-48 MEDE006W
|
Facility
OP
|
$50.50
|
|
| Hospital Charge Code |
64906556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$40.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.25
|
| Rate for Payer: Aetna Government |
$25.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.34
|
| Rate for Payer: Group Health Inc Commercial |
$25.25
|
| Rate for Payer: Group Health Inc Medicare |
$17.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.25
|
|
|
BRASSELER TEAR RASP. LG
|
Facility
OP
|
$151.46
|
|
| Hospital Charge Code |
40208124
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.01 |
| Max. Negotiated Rate |
$121.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.73
|
| Rate for Payer: Aetna Government |
$75.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$121.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.99
|
| Rate for Payer: Group Health Inc Commercial |
$75.73
|
| Rate for Payer: Group Health Inc Medicare |
$53.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.73
|
|
|
BRASSLER ROUND GARBIDE BUR 5MM
|
Facility
OP
|
$13.34
|
|
| Hospital Charge Code |
40205589
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.67
|
| Rate for Payer: Aetna Government |
$6.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.07
|
| Rate for Payer: Group Health Inc Commercial |
$6.67
|
| Rate for Payer: Group Health Inc Medicare |
$4.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.67
|
|
|
BRA SURGICAL LARGE BREAST SUPPORT
|
Facility
OP
|
$36.60
|
|
| Hospital Charge Code |
64904001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$29.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.30
|
| Rate for Payer: Aetna Government |
$18.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.89
|
| Rate for Payer: Group Health Inc Commercial |
$18.30
|
| Rate for Payer: Group Health Inc Medicare |
$12.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.30
|
|
|
BRA SURGICAL MED BREAST SUPPORT
|
Facility
OP
|
$36.60
|
|
| Hospital Charge Code |
64904188
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$29.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.30
|
| Rate for Payer: Aetna Government |
$18.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.89
|
| Rate for Payer: Group Health Inc Commercial |
$18.30
|
| Rate for Payer: Group Health Inc Medicare |
$12.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.30
|
|
