|
BUTORPHANOL SD 2MG/ML
|
Facility
OP
|
$14.52
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
41650382
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.94
|
| Rate for Payer: Aetna Government |
$2.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.54
|
| Rate for Payer: Group Health Inc Commercial |
$7.26
|
| Rate for Payer: Group Health Inc Medicare |
$5.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.79
|
| Rate for Payer: SOMOS Essential |
$3.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.44
|
|
|
BUTTERFLY SET 19G
|
Facility
OP
|
$4.97
|
|
| Hospital Charge Code |
40509802
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
|
|
BUTTERFLY SET 21G
|
Facility
OP
|
$4.97
|
|
| Hospital Charge Code |
40509803
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
|
|
BUTTERFLY SET 23G
|
Facility
OP
|
$4.97
|
|
| Hospital Charge Code |
40509804
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
|
|
BUTTON ARCOM
|
Facility
OP
|
$1,314.00
|
|
| Hospital Charge Code |
40202262
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$459.90 |
| Max. Negotiated Rate |
$1,051.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$722.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$657.00
|
| Rate for Payer: Aetna Government |
$657.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,051.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$893.52
|
| Rate for Payer: Group Health Inc Commercial |
$657.00
|
| Rate for Payer: Group Health Inc Medicare |
$459.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$657.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.00
|
|
|
BUTTON PATELLA STD
|
Facility
OP
|
$1,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,482.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$776.60
|
| 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 |
$706.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$811.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,482.60
|
| Rate for Payer: Group Health Inc Commercial |
$706.00
|
| Rate for Payer: Group Health Inc Medicare |
$494.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$706.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$706.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$917.80
|
|
|
BUTTON PATELLA STD
|
Facility
IP
|
$1,412.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202035
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$706.00 |
| Max. Negotiated Rate |
$706.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$706.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$706.00
|
|
|
BUTTON PATELLA STD #11-150828
|
Facility
IP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.00 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
|
|
BUTTON PATELLA STD #11-150828
|
Facility
OP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,289.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$675.40
|
| 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 |
$614.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$706.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,289.40
|
| Rate for Payer: Group Health Inc Commercial |
$614.00
|
| Rate for Payer: Group Health Inc Medicare |
$429.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.20
|
|
|
BUTTON PATELLA STD #11-150838
|
Facility
OP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,289.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$675.40
|
| 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 |
$614.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$706.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,289.40
|
| Rate for Payer: Group Health Inc Commercial |
$614.00
|
| Rate for Payer: Group Health Inc Medicare |
$429.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.20
|
|
|
BUTTON PATELLA STD #11-150838
|
Facility
IP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209585
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.00 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
|
|
BX BREASTS PERCUT W/O IMAGE
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
30305681
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.75 |
| 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 |
$79.75
|
| 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 |
$88.61
|
| 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
|
|
|
BX OF OVARY, UNILAT OR BILAT
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58900
|
| Hospital Charge Code |
40052248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$492.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$547.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
BX PALATE
|
Facility
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
40011260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$121.52
|
| 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 |
$135.02
|
| 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
|
|
|
BX PLT 4H .4MM 10MMX10MM
|
Facility
OP
|
$558.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.90
|
| 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 |
$279.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$320.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$585.90
|
| Rate for Payer: Group Health Inc Commercial |
$279.00
|
| Rate for Payer: Group Health Inc Medicare |
$195.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.70
|
|
|
BX PLT 4H .4MM 10MMX10MM
|
Facility
IP
|
$558.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205298
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.00
|
|
|
BX VAG MUCOSA, EXTENSIVE
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57105
|
| Hospital Charge Code |
30301267
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.75 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| 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 |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$181.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
BX VULVA OR PERINEUM EA ADDLESION
|
Facility
OP
|
$106.40
|
|
|
Service Code
|
HCPCS 56606
|
| Hospital Charge Code |
42201728
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.21
|
| Rate for Payer: Aetna Government |
$37.21
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$33.26
|
| 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 |
$53.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.95
|
|
|
BYPASS GRAFT AORTO-RENAL
|
Facility
OP
|
$5,350.60
|
|
|
Service Code
|
HCPCS 35560
|
| Hospital Charge Code |
40039874
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$2,942.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,942.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,957.39
|
| Rate for Payer: Aetna Government |
$1,957.39
|
| 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 |
$1,949.65
|
| Rate for Payer: Group Health Inc Commercial |
$2,675.30
|
| Rate for Payer: Group Health Inc Medicare |
$1,872.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,675.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,675.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,166.28
|
|
|
BYPASS GRAFT ILIO-ILIAC
|
Facility
OP
|
$4,086.70
|
|
|
Service Code
|
HCPCS 35563
|
| Hospital Charge Code |
40039875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,430.34 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,247.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,514.46
|
| Rate for Payer: Aetna Government |
$1,514.46
|
| 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 |
$1,514.31
|
| Rate for Payer: Group Health Inc Commercial |
$2,043.35
|
| Rate for Payer: Group Health Inc Medicare |
$1,430.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,043.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,682.57
|
|
|
C001-IGE PENICILLIN G
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
C002-IGE PENICILLIN V
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
C006-IGE AMOXICILLOYL
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729771
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
C1 ESTERASE INHIBITOR, SERUM
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
40609138
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.60
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
C203-IGE AMPICILLIN
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729837
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
