|
ABDOMINAL PARACENTESIS W/O IMAGE
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
30105563
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,048.28
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ABDOMINAL PARACENTESIS W/O IMAGE
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
30305563
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,048.28
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ABDOMINAL PARACERTESIS
|
Facility
OP
|
$25.52
|
|
| Hospital Charge Code |
40200290
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.76
|
| Rate for Payer: Aetna Government |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.35
|
| Rate for Payer: Group Health Inc Commercial |
$12.76
|
| Rate for Payer: Group Health Inc Medicare |
$8.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.76
|
|
|
ABDOMINAL TUBAL LIGATION
|
Facility
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 58670
|
| Hospital Charge Code |
40052255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$417.54 |
| Max. Negotiated Rate |
$7,320.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$417.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$463.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
ABDOMINOPLASTY
|
Facility
OP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
40014292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,323.99 |
| Max. Negotiated Rate |
$7,931.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,541.13
|
| Rate for Payer: Aetna Government |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,541.13
|
| 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 |
$7,541.13
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,323.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,409.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,711.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,541.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,711.61
|
| Rate for Payer: Group Health Inc Commercial |
$7,541.13
|
| Rate for Payer: Group Health Inc Medicare |
$7,541.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,931.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,541.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,471.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,409.96
|
| Rate for Payer: Healthfirst QHP |
$7,541.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,541.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,541.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,032.90
|
| Rate for Payer: Wellcare Medicare |
$7,164.07
|
|
|
ABD PARACENTESIS
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
40021755
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ABD PERINEAL RESECTION
|
Facility
OP
|
$5,368.92
|
|
|
Service Code
|
HCPCS 45110
|
| Hospital Charge Code |
40011150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$2,952.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,952.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,170.32
|
| Rate for Payer: Aetna Government |
$2,170.32
|
| 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 |
$2,034.80
|
| Rate for Payer: Group Health Inc Commercial |
$2,684.46
|
| Rate for Payer: Group Health Inc Medicare |
$1,879.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,684.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,684.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,260.89
|
|
|
AB, EBNA
|
Facility
OP
|
$38.23
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
30305618
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$24.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.29
|
| Rate for Payer: Aetna Government |
$15.29
|
| Rate for Payer: Cash Price |
$15.29
|
| Rate for Payer: Cash Price |
$15.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.29
|
| Rate for Payer: EmblemHealth Commercial |
$15.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.61
|
| Rate for Payer: Group Health Inc Commercial |
$15.29
|
| Rate for Payer: Group Health Inc Medicare |
$15.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.29
|
| Rate for Payer: Healthfirst QHP |
$15.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.23
|
| Rate for Payer: Wellcare Medicare |
$13.76
|
|
|
ABEON MALE URO RETRACT SYS
|
Facility
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40003447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.00
|
|
|
ABEON MALE URO RETRACT SYS
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40003447
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$3,775.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$275.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$316.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$577.50
|
| Rate for Payer: Group Health Inc Commercial |
$275.00
|
| Rate for Payer: Group Health Inc Medicare |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.50
|
|
|
ABG'S 100% OXYGEN -ARTERIAL PUNCT
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 36600 TC
|
| Hospital Charge Code |
40402702
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$115.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Government |
$165.12
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$165.12
|
| Rate for Payer: Group Health Inc Medicare |
$115.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.12
|
|
|
ABG'S 100% OXYGEN-ARTERIAL PUNCT
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 36600 TC
|
| Hospital Charge Code |
30103256
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Government |
$165.12
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ABG'S REST & EXERCI-ARTERIAL PUNC
|
Facility
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 94680 TC
|
| Hospital Charge Code |
40402703
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$336.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$210.50
|
| Rate for Payer: Aetna Government |
$210.50
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$336.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$286.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.03
|
| Rate for Payer: Group Health Inc Commercial |
$210.50
|
| Rate for Payer: Group Health Inc Medicare |
$147.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.03
|
|
|
AB G/W ACCESSORY KIT CO/P
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66522099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
|
|
AB G/W ACCESSORY KIT CO/P
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66522099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.50
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|
|
Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$171.03 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$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 |
$171.03
|
| 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 Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.03
|
| 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
|
|
|
ABN PTT/APTT REFLEXIVE PANEL
|
Facility
OP
|
$152.95
|
|
|
Service Code
|
HCPCS 80503
|
| Hospital Charge Code |
40629202
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.65 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.66
|
| Rate for Payer: Aetna Government |
$62.66
|
| Rate for Payer: Brighton Health Commercial |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$122.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$104.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.77
|
| Rate for Payer: Group Health Inc Commercial |
$62.66
|
| Rate for Payer: Group Health Inc Medicare |
$62.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare |
$56.39
|
|
|
ABN PTT/APTT REFLEXIVE PANEL
|
Facility
OP
|
$13.05
|
|
| Hospital Charge Code |
40629292
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.52
|
| Rate for Payer: Aetna Government |
$6.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.87
|
| Rate for Payer: Group Health Inc Commercial |
$6.52
|
| Rate for Payer: Group Health Inc Medicare |
$4.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.52
|
|
|
ABO GROUPING AND RHO(D) TYPING
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
40709827
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$181.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.72
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$132.95
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$18,771.80
|
|
|
Service Code
|
MS-DRG 770
|
| Min. Negotiated Rate |
$6,848.85 |
| Max. Negotiated Rate |
$18,771.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,776.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,403.73
|
| Rate for Payer: Aetna Government |
$18,403.73
|
| Rate for Payer: Brighton Health Commercial |
$11,581.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,771.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,792.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,382.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,483.54
|
| Rate for Payer: EmblemHealth Commercial |
$6,848.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,403.73
|
| Rate for Payer: Group Health Inc Commercial |
$18,403.73
|
| Rate for Payer: Group Health Inc Medicare |
$18,403.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,403.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,557.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,403.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,403.73
|
| Rate for Payer: Wellcare Medicare |
$17,483.54
|
|
|
ABORTION WITHOUT D&C
|
Facility
IP
|
$21,466.37
|
|
|
Service Code
|
MS-DRG 779
|
| Min. Negotiated Rate |
$8,482.39 |
| Max. Negotiated Rate |
$21,466.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,585.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,045.46
|
| Rate for Payer: Aetna Government |
$21,045.46
|
| Rate for Payer: Brighton Health Commercial |
$14,343.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,466.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,082.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,097.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,993.19
|
| Rate for Payer: EmblemHealth Commercial |
$8,482.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,045.46
|
| Rate for Payer: Group Health Inc Commercial |
$21,045.46
|
| Rate for Payer: Group Health Inc Medicare |
$21,045.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,045.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,786.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,045.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,045.46
|
| Rate for Payer: Wellcare Medicare |
$19,993.19
|
|
|
ABRASION TREATMENT OF SKIN
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 15781
|
| Hospital Charge Code |
40064080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$476.38 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$476.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$529.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
ABUTMENT SUPPORTED CROWN TITANIUM
|
Facility
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS D6094
|
| Hospital Charge Code |
42300721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.92 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,100.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302.92
|
| Rate for Payer: Aetna Government |
$302.92
|
| 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 |
$1,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,000.00
|
|
|
ACAMPROSATE CALCIUM TABLET
|
Facility
OP
|
$4.39
|
|
| Hospital Charge Code |
41640317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.20
|
| Rate for Payer: Aetna Government |
$2.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.99
|
| Rate for Payer: Group Health Inc Commercial |
$2.20
|
| Rate for Payer: Group Health Inc Medicare |
$1.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.85
|
|
|
ACAMPROSATE CALCIUM TABLET
|
Facility
OP
|
$4.39
|
|
| Hospital Charge Code |
41650317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.20
|
| Rate for Payer: Aetna Government |
$2.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.99
|
| Rate for Payer: Group Health Inc Commercial |
$2.20
|
| Rate for Payer: Group Health Inc Medicare |
$1.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.85
|
|
