|
CARFILZOMIB 30MG INJECTION
|
Facility
OP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41659595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$55.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$47.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
| Rate for Payer: Wellcare Medicare |
$44.73
|
|
|
CARFILZOMIB 30MG INJECTION
|
Facility
OP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41649595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$55.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$47.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
| Rate for Payer: Wellcare Medicare |
$44.73
|
|
|
CARFILZOMIB 30MG INJECTION
|
Facility
IP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41659595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
|
|
CARFILZOMIB 30MG INJECTION
|
Facility
IP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41649595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
|
|
CARFILZOMIB 60MG INJECTION
|
Facility
OP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41649593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$55.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$47.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
| Rate for Payer: Wellcare Medicare |
$44.73
|
|
|
CARFILZOMIB 60MG INJECTION
|
Facility
IP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41659593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
|
|
CARFILZOMIB 60MG INJECTION
|
Facility
IP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41649593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
|
|
CARFILZOMIB 60MG INJECTION
|
Facility
OP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41659593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$55.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$47.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
| Rate for Payer: Wellcare Medicare |
$44.73
|
|
|
CARIES SUSCEPTIBILITY TESTS
|
Facility
OP
|
$66.62
|
|
|
Service Code
|
HCPCS D0425
|
| Hospital Charge Code |
42300200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.19
|
| Rate for Payer: Aetna Government |
$9.19
|
| 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: Group Health Inc Commercial |
$33.31
|
| Rate for Payer: Group Health Inc Medicare |
$23.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.31
|
|
|
CARMUSTINE 100 MG INJ
|
Facility
OP
|
$154.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
41640827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$410.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$271.46
|
| Rate for Payer: Aetna Government |
$271.46
|
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$271.46
|
| Rate for Payer: EmblemHealth Commercial |
$271.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.04
|
| Rate for Payer: Group Health Inc Commercial |
$271.46
|
| Rate for Payer: Group Health Inc Medicare |
$271.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$410.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.75
|
| Rate for Payer: Healthfirst QHP |
$271.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.78
|
| Rate for Payer: SOMOS Essential |
$297.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$217.17
|
| Rate for Payer: Wellcare Medicare |
$257.89
|
|
|
CARMUSTINE 100 MG INJ
|
Facility
OP
|
$154.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
41650827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$410.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$271.46
|
| Rate for Payer: Aetna Government |
$271.46
|
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$271.46
|
| Rate for Payer: EmblemHealth Commercial |
$271.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.04
|
| Rate for Payer: Group Health Inc Commercial |
$271.46
|
| Rate for Payer: Group Health Inc Medicare |
$271.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$410.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.75
|
| Rate for Payer: Healthfirst QHP |
$271.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.78
|
| Rate for Payer: SOMOS Essential |
$297.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$217.17
|
| Rate for Payer: Wellcare Medicare |
$257.89
|
|
|
CARMUSTINE 100 MG INJ
|
Facility
IP
|
$154.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
41640827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
|
|
CARMUSTINE 100 MG INJ
|
Facility
IP
|
$154.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
41650827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
IP
|
$40,000.22
|
|
|
Service Code
|
MS-DRG 035
|
| Min. Negotiated Rate |
$18,235.39 |
| Max. Negotiated Rate |
$40,000.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,906.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39,215.90
|
| Rate for Payer: Aetna Government |
$39,215.90
|
| Rate for Payer: Brighton Health Commercial |
$33,342.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40,000.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39,710.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,770.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$37,255.10
|
| Rate for Payer: EmblemHealth Commercial |
$19,718.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$39,215.90
|
| Rate for Payer: Group Health Inc Commercial |
$39,215.90
|
| Rate for Payer: Group Health Inc Medicare |
$39,215.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39,215.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,235.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39,215.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39,215.90
|
| Rate for Payer: Wellcare Medicare |
$37,255.10
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH MCC
|
Facility
IP
|
$67,373.28
|
|
|
Service Code
|
MS-DRG 034
|
| Min. Negotiated Rate |
$28,564.98 |
| Max. Negotiated Rate |
$67,373.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57,526.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61,430.06
|
| Rate for Payer: Aetna Government |
$61,430.06
|
| Rate for Payer: Brighton Health Commercial |
$56,570.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62,658.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67,373.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55,599.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$58,358.56
|
| Rate for Payer: EmblemHealth Commercial |
$33,454.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$61,430.06
|
| Rate for Payer: Group Health Inc Commercial |
$61,430.06
|
| Rate for Payer: Group Health Inc Medicare |
$61,430.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61,430.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28,564.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61,430.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61,430.06
|
| Rate for Payer: Wellcare Medicare |
$58,358.56
|
|
|
CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$33,050.92
|
|
|
Service Code
|
MS-DRG 036
|
| Min. Negotiated Rate |
$15,067.33 |
| Max. Negotiated Rate |
$33,050.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,661.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,402.86
|
| Rate for Payer: Aetna Government |
$32,402.86
|
| Rate for Payer: Brighton Health Commercial |
$26,218.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,050.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,225.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,768.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,782.72
|
| Rate for Payer: EmblemHealth Commercial |
$15,505.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,402.86
|
| Rate for Payer: Group Health Inc Commercial |
$32,402.86
|
| Rate for Payer: Group Health Inc Medicare |
$32,402.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,402.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,067.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,402.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,402.86
|
| Rate for Payer: Wellcare Medicare |
$30,782.72
|
|
|
CAROTID ENDARTARECTOMY
|
Facility
OP
|
$6,846.53
|
|
|
Service Code
|
HCPCS 35301
|
| Hospital Charge Code |
40034320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,290.82 |
| Max. Negotiated Rate |
$3,765.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,765.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,290.82
|
| Rate for Payer: Aetna Government |
$1,290.82
|
| 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 |
$1,293.51
|
| Rate for Payer: Group Health Inc Commercial |
$3,423.26
|
| Rate for Payer: Group Health Inc Medicare |
$2,396.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,423.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,423.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,437.23
|
|
|
CARPAL TUNNEL INJ
|
Facility
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
30305722
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.38 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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: Elderplan Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
CARPAL TUNNEL RELEASE
|
Facility
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64721
|
| Hospital Charge Code |
40021435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$496.67 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$496.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
| Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$551.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
Carpectomy; 1 bone
|
Facility
OP
|
$3,743.15
|
|
|
Service Code
|
CPT 25210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$561.97 |
| Max. Negotiated Rate |
$3,743.15 |
| 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: 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 |
$561.97
|
| 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 Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$624.41
|
| 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
|
|
|
Carpectomy; all bones of proximal row
|
Facility
OP
|
$3,743.15
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.78 |
| Max. Negotiated Rate |
$3,743.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$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 |
$704.78
|
| 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 Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$783.09
|
| 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
|
|
|
CARPECTOMY ALL BONES PROX ROW
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 25215
|
| Hospital Charge Code |
40029963
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.78 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$704.78
|
| 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 |
$783.09
|
| 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
|
|
|
CARPECTOMY ONE BONE
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
40029962
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$561.97 |
| 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 |
$561.97
|
| 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 |
$624.41
|
| 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
|
|
|
CARPECTOMY W IMPLANT DISTAL RADIU
|
Facility
OP
|
$36,044.28
|
|
|
Service Code
|
HCPCS 25441
|
| Hospital Charge Code |
40029964
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,069.77 |
| Max. Negotiated Rate |
$18,022.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,219.83
|
| Rate for Payer: Aetna Government |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15,219.83
|
| 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 |
$15,219.83
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,069.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12,936.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13,545.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,219.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13,545.65
|
| Rate for Payer: Group Health Inc Commercial |
$15,219.83
|
| Rate for Payer: Group Health Inc Medicare |
$15,219.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,022.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,219.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,188.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,936.86
|
| Rate for Payer: Healthfirst QHP |
$15,219.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,219.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,219.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,175.86
|
| Rate for Payer: Wellcare Medicare |
$14,458.84
|
|
|
CARPECTOMY W IMPLANT DISTAL ULNA
|
Facility
OP
|
$48,296.70
|
|
|
Service Code
|
HCPCS 25442
|
| Hospital Charge Code |
40029965
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$918.49 |
| Max. Negotiated Rate |
$24,148.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,551.15
|
| Rate for Payer: Aetna Government |
$21,551.15
|
| Rate for Payer: Cash Price |
$21,551.15
|
| Rate for Payer: Cash Price |
$21,551.15
|
| Rate for Payer: Cash Price |
$21,551.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,551.15
|
| 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 |
$21,551.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$918.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18,318.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19,180.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,551.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19,180.52
|
| Rate for Payer: Group Health Inc Commercial |
$21,551.15
|
| Rate for Payer: Group Health Inc Medicare |
$21,551.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,148.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,551.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,020.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,318.48
|
| Rate for Payer: Healthfirst QHP |
$21,551.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,551.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,551.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17,240.92
|
| Rate for Payer: Wellcare Medicare |
$20,473.59
|
|
