|
CARMUSTINE 100 MG IV SOLR [28911]
|
Facility
|
OP
|
$2,142.88
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
00781347432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$217.17 |
| Max. Negotiated Rate |
$1,392.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,178.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$271.46
|
| Rate for Payer: Aetna Government |
$271.46
|
| Rate for Payer: Brighton Health Commercial |
$1,285.73
|
| 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 |
$1,071.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,232.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$271.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,071.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.46
|
| 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 |
$1,071.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,071.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.75
|
| Rate for Payer: Healthfirst QHP |
$271.46
|
| Rate for Payer: Humana Medicare |
$276.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,392.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$217.17
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
|
IP
|
$53,921.86
|
|
|
Service Code
|
MSDRG 035
|
| Min. Negotiated Rate |
$18,235.39 |
| Max. Negotiated Rate |
$53,921.86 |
| 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: Humana Medicare |
$53,921.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39,215.90
|
| Rate for Payer: United Healthcare Commercial |
$45,730.16
|
| Rate for Payer: United Healthcare 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
|
$84,466.33
|
|
|
Service Code
|
MSDRG 034
|
| Min. Negotiated Rate |
$28,564.98 |
| Max. Negotiated Rate |
$84,466.33 |
| 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: Humana Medicare |
$84,466.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61,430.06
|
| Rate for Payer: United Healthcare Commercial |
$77,587.14
|
| Rate for Payer: United Healthcare 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
|
$44,553.93
|
|
|
Service Code
|
MSDRG 036
|
| Min. Negotiated Rate |
$15,067.33 |
| Max. Negotiated Rate |
$44,553.93 |
| 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: Humana Medicare |
$44,553.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,402.86
|
| Rate for Payer: United Healthcare Commercial |
$35,959.67
|
| Rate for Payer: United Healthcare 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 |
$5,134.90 |
| 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: Brighton Health Commercial |
$5,134.90
|
| 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: 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: United Healthcare Commercial |
$1,496.00
|
|
|
CARPAL TUNNEL INJ
|
Facility
|
IP
|
$792.83
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
30305722
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
CARPAL TUNNEL INJ
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
30305722
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| 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: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| 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: 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 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 Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| 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: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64721
|
| Hospital Charge Code |
40021435
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
CARPAL TUNNEL RELEASE
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64721
|
| Hospital Charge Code |
40021435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,905.61 |
| 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: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$3,905.61
|
| 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 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 Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
$3,818.01
|
|
|
Service Code
|
CPT 25210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,818.01 |
| 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: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| 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 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 Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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
|
$3,818.01
|
|
|
Service Code
|
CPT 25215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,818.01 |
| 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: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| 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 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 Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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 |
$1,505.00 |
| Max. Negotiated Rate |
$6,218.29 |
| 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: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| 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 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 Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 25215
|
| Hospital Charge Code |
40029963
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
CARPECTOMY ONE BONE
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
40029962
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,218.29 |
| 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: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| 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 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 Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
40029962
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
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 |
$1,505.00 |
| Max. Negotiated Rate |
$27,033.21 |
| 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: Affinity Essential Plan 1&2 |
$10,653.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10,653.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10,653.88
|
| Rate for Payer: Brighton Health Commercial |
$27,033.21
|
| 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 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 Medicare Advantage |
$12,936.86
|
| Rate for Payer: Healthfirst QHP |
$15,219.83
|
| Rate for Payer: Humana Medicare |
$15,524.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,219.83
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare 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 RADIU
|
Facility
|
IP
|
$36,044.28
|
|
|
Service Code
|
HCPCS 25441
|
| Hospital Charge Code |
40029964
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$15,219.83
|
|
|
CARPECTOMY W IMPLANT DISTAL ULNA
|
Facility
|
IP
|
$48,296.70
|
|
|
Service Code
|
HCPCS 25442
|
| Hospital Charge Code |
40029965
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$21,551.15
|
|
|
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 |
$1,505.00 |
| Max. Negotiated Rate |
$36,222.52 |
| 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: Affinity Essential Plan 1&2 |
$15,085.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15,085.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15,085.80
|
| Rate for Payer: Brighton Health Commercial |
$36,222.52
|
| 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 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 Medicare Advantage |
$18,318.48
|
| Rate for Payer: Healthfirst QHP |
$21,551.15
|
| Rate for Payer: Humana Medicare |
$21,982.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,551.15
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CARRIER DERMA 1/2-1 EXPAN
|
Facility
|
OP
|
$44.30
|
|
| Hospital Charge Code |
64902693
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$35.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.15
|
| Rate for Payer: Aetna Government |
$22.15
|
| Rate for Payer: Brighton Health Commercial |
$33.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.12
|
| Rate for Payer: Group Health Inc Commercial |
$22.15
|
| Rate for Payer: Group Health Inc Medicare |
$15.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.15
|
|
|
CARTRIDGE EMERALD UNFOLDER
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
64906897
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$187.50
|
| Rate for Payer: Aetna Government |
$187.50
|
| Rate for Payer: Brighton Health Commercial |
$281.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.00
|
| Rate for Payer: Group Health Inc Commercial |
$187.50
|
| Rate for Payer: Group Health Inc Medicare |
$131.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.50
|
|
|
CARTRIDGE,ENFLOW DISP W/3EXS
|
Facility
|
OP
|
$25.20
|
|
| Hospital Charge Code |
64903386
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.60
|
| Rate for Payer: Aetna Government |
$12.60
|
| Rate for Payer: Brighton Health Commercial |
$18.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.14
|
| Rate for Payer: Group Health Inc Commercial |
$12.60
|
| Rate for Payer: Group Health Inc Medicare |
$8.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.60
|
|
|
CARTRIDGE FILTER DISP
|
Facility
|
OP
|
$1.67
|
|
| Hospital Charge Code |
64902863
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
CARVEDILOL 12.5 MG PO TABS [15749]
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
NDC 51079093120
|
| Hospital Charge Code |
51079093120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.07
|
| Rate for Payer: Aetna Government |
$1.07
|
| Rate for Payer: Brighton Health Commercial |
$1.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.45
|
| Rate for Payer: Group Health Inc Commercial |
$1.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.39
|
|
|
CARVEDILOL 12.5 MG PO TABS [15749]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
NDC 00904630261
|
| Hospital Charge Code |
00904630261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.37
|
|
