|
BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS [8958]
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
00603254421
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.10
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2-2-14 % EX AERO [9328]
|
Facility
|
OP
|
$7.14
|
|
|
Service Code
|
NDC 10223020103
|
| Hospital Charge Code |
10223020103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.57
|
| Rate for Payer: Aetna Government |
$3.57
|
| Rate for Payer: Brighton Health Commercial |
$5.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.86
|
| Rate for Payer: Group Health Inc Commercial |
$3.57
|
| Rate for Payer: Group Health Inc Medicare |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.64
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2-2-14 % EX AERO [9328]
|
Facility
|
OP
|
$14.64
|
|
|
Service Code
|
NDC 10223020104
|
| Hospital Charge Code |
10223020104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.32
|
| Rate for Payer: Aetna Government |
$7.32
|
| Rate for Payer: Brighton Health Commercial |
$10.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.96
|
| Rate for Payer: Group Health Inc Commercial |
$7.32
|
| Rate for Payer: Group Health Inc Medicare |
$5.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.52
|
|
|
BUTORPHANOL SD 2MG/ML
|
Facility
|
IP
|
$14.52
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
41640382
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
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: Brighton Health Commercial |
$8.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.35
|
| 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: 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
|
|
|
BUTORPHANOL SD 2MG/ML
|
Facility
|
OP
|
$14.52
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
41640382
|
|
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: Brighton Health Commercial |
$8.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.35
|
| 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: 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
|
|
|
BUTORPHANOL SD 2MG/ML
|
Facility
|
IP
|
$14.52
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
41650382
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN [9333]
|
Facility
|
OP
|
$8.09
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
00409162301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$6.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.94
|
| Rate for Payer: Aetna Government |
$2.94
|
| Rate for Payer: Brighton Health Commercial |
$6.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.50
|
| Rate for Payer: Group Health Inc Commercial |
$4.05
|
| Rate for Payer: Group Health Inc Medicare |
$2.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.26
|
|
|
BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN [9334]
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
00409162601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$7.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.94
|
| Rate for Payer: Aetna Government |
$2.94
|
| Rate for Payer: Brighton Health Commercial |
$7.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.73
|
| Rate for Payer: Group Health Inc Commercial |
$4.95
|
| Rate for Payer: Group Health Inc Medicare |
$3.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.43
|
|
|
BUTTERFLY SET 19G
|
Facility
|
OP
|
$4.97
|
|
| Hospital Charge Code |
40509802
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$76.00 |
| 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: Brighton Health Commercial |
$3.73
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
BUTTERFLY SET 21G
|
Facility
|
OP
|
$4.97
|
|
| Hospital Charge Code |
40509803
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$76.00 |
| 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: Brighton Health Commercial |
$3.73
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
BUTTERFLY SET 23G
|
Facility
|
OP
|
$4.97
|
|
| Hospital Charge Code |
40509804
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$76.00 |
| 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: Brighton Health Commercial |
$3.73
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
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: Brighton Health Commercial |
$985.50
|
| 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
|
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
|
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: Brighton Health Commercial |
$847.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$706.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$811.90
|
| Rate for Payer: EmblemHealth Commercial |
$706.00
|
| 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 #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: Brighton Health Commercial |
$736.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$614.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$706.10
|
| Rate for Payer: EmblemHealth Commercial |
$614.00
|
| 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 #11-150828
|
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 #11-150838
|
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: Brighton Health Commercial |
$736.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$614.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$706.10
|
| Rate for Payer: EmblemHealth Commercial |
$614.00
|
| 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 |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| 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: 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 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 Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| 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: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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 BREASTS PERCUT W/O IMAGE
|
Facility
|
IP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
30305681
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,874.89
|
|
|
BX OF OVARY, UNILAT OR BILAT
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58900
|
| Hospital Charge Code |
40052248
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
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 |
$1,468.00 |
| Max. Negotiated Rate |
$5,674.60 |
| 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: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| 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 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 Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
40011260
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,763.60
|
|
|
BX PALATE
|
Facility
|
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 42100
|
| Hospital Charge Code |
40011260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,065.12 |
| 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: Affinity Essential Plan 1&2 |
$1,234.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,234.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,234.52
|
| Rate for Payer: Brighton Health Commercial |
$3,065.12
|
| 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 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 Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Humana Medicare |
$1,798.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare 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
|
|
