|
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 |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| Rate for Payer: Cash Price |
$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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$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 |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare 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 |
$140.33
|
|
|
ABG'S 100% OXYGEN-ARTERIAL PUNCT
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 36600 TC
|
| Hospital Charge Code |
30103256
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
ABG'S REST & EXERCI-ARTERIAL PUNC
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
HCPCS 94680 TC
|
| Hospital Charge Code |
40402703
|
|
Hospital Revenue Code
|
460
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
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 |
$126.45 |
| Max. Negotiated Rate |
$336.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$315.75
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
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: Brighton Health Commercial |
$78.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.75
|
| Rate for Payer: EmblemHealth Commercial |
$65.00
|
| 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
|
|
|
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
|
|
|
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 |
$1,234.52 |
| 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: 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: 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 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
|
|
|
ABLYSINOL IA SOLN [166645]
|
Facility
|
OP
|
$199.90
|
|
|
Service Code
|
NDC 54288010515
|
| Hospital Charge Code |
54288010515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.96 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.95
|
| Rate for Payer: Aetna Government |
$99.95
|
| Rate for Payer: Brighton Health Commercial |
$149.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$159.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$135.93
|
| Rate for Payer: Group Health Inc Commercial |
$99.95
|
| Rate for Payer: Group Health Inc Medicare |
$69.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.94
|
|
|
ABLYSINOL IA SOLN [166645]
|
Facility
|
OP
|
$199.90
|
|
|
Service Code
|
NDC 54288010502
|
| Hospital Charge Code |
54288010502
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.96 |
| Max. Negotiated Rate |
$159.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.95
|
| Rate for Payer: Aetna Government |
$99.95
|
| Rate for Payer: Brighton Health Commercial |
$149.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$159.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$135.93
|
| Rate for Payer: Group Health Inc Commercial |
$99.95
|
| Rate for Payer: Group Health Inc Medicare |
$69.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.94
|
|
|
ABN PTT/APTT REFLEXIVE PANEL
|
Facility
|
IP
|
$152.95
|
|
|
Service Code
|
HCPCS 80503
|
| Hospital Charge Code |
40629202
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$62.66
|
|
|
ABN PTT/APTT REFLEXIVE PANEL
|
Facility
|
OP
|
$152.95
|
|
|
Service Code
|
HCPCS 80503
|
| Hospital Charge Code |
40629202
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.86 |
| 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: Affinity Essential Plan 1&2 |
$43.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.86
|
| 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 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 Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Humana Medicare |
$63.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: United Healthcare 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: Brighton Health Commercial |
$9.79
|
| 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
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
40709827
|
|
Hospital Revenue Code
|
309
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
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 |
$3.78 |
| Max. Negotiated Rate |
$247.67 |
| 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: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| 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 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 Medicare Advantage |
$147.72
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare 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
|
$25,305.13
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$6,848.85 |
| Max. Negotiated Rate |
$25,305.13 |
| 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: Humana Medicare |
$25,305.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,403.73
|
| Rate for Payer: United Healthcare Commercial |
$15,883.75
|
| Rate for Payer: United Healthcare 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
|
$28,937.51
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$8,482.39 |
| Max. Negotiated Rate |
$28,937.51 |
| 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: Humana Medicare |
$28,937.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,045.46
|
| Rate for Payer: United Healthcare Commercial |
$19,672.22
|
| Rate for Payer: United Healthcare 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 |
$569.54 |
| 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: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Brighton Health Commercial |
$1,385.68
|
| 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 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 Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare 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
|
|
|
ABRASION TREATMENT OF SKIN
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 15781
|
| Hospital Charge Code |
40064080
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$813.63
|
|
|
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: Brighton Health Commercial |
$1,500.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: 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 333 MG PO TBEC [39720]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 68462043518
|
| Hospital Charge Code |
68462043518
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.88
|
| Rate for Payer: Aetna Government |
$0.88
|
| Rate for Payer: Brighton Health Commercial |
$1.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
ACAMPROSATE CALCIUM 333 MG PO TBEC [39720]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 68382056928
|
| Hospital Charge Code |
68382056928
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.88
|
| Rate for Payer: Aetna Government |
$0.88
|
| Rate for Payer: Brighton Health Commercial |
$1.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
ACAMPROSATE CALCIUM 333 MG PO TBEC [39720]
|
Facility
|
OP
|
$2.71
|
|
|
Service Code
|
NDC 60687012125
|
| Hospital Charge Code |
60687012125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.36
|
| Rate for Payer: Aetna Government |
$1.36
|
| Rate for Payer: Brighton Health Commercial |
$2.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.84
|
| Rate for Payer: Group Health Inc Commercial |
$1.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.76
|
|
|
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: Brighton Health Commercial |
$3.29
|
| 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 |
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: Brighton Health Commercial |
$3.29
|
| 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
|
|
|
ACCESSION OF BRUSH BIOPSY
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS D0486
|
| Hospital Charge Code |
42303418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.27
|
| Rate for Payer: Aetna Government |
$35.27
|
| Rate for Payer: Brighton Health Commercial |
$112.50
|
| 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 |
$75.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
|
