|
CMF SCRW 1.5MM TIT CRA STRDRV 4MM
|
Facility
OP
|
$590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.50 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$324.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$295.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$339.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.50
|
| Rate for Payer: Group Health Inc Commercial |
$295.00
|
| Rate for Payer: Group Health Inc Medicare |
$206.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$383.50
|
|
|
CMF SCRW 1.5MM TIT CRA STRDRV 4MM
|
Facility
IP
|
$590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.00 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.00
|
|
|
CMF SCRW 1.5 TIT CRAN W/STARDRIVE
|
Facility
OP
|
$590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$324.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$295.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$339.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.50
|
| Rate for Payer: Group Health Inc Commercial |
$295.00
|
| Rate for Payer: Group Health Inc Medicare |
$206.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$383.50
|
|
|
CMF SCRW 1.5 TIT CRAN W/STARDRIVE
|
Facility
IP
|
$590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.00 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.00
|
|
|
CMF SCRW TIT NEURO SLFDR 3MM LPRO
|
Facility
IP
|
$676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.00
|
|
|
CMF SCRW TIT NEURO SLFDR 3MM LPRO
|
Facility
OP
|
$676.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$709.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$371.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$338.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$388.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$709.80
|
| Rate for Payer: Group Health Inc Commercial |
$338.00
|
| Rate for Payer: Group Health Inc Medicare |
$236.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.40
|
|
|
CMF SCRW TIT NEURO S/T 1.2X L/P
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.00
|
| Rate for Payer: Group Health Inc Commercial |
$80.00
|
| Rate for Payer: Group Health Inc Medicare |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.00
|
|
|
CMF SCRW TIT NEURO S/T 1.2X L/P
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
|
|
CMMI ASYNTELEHEALTH 10-20MIN
|
Professional
|
$134.02
|
|
|
Service Code
|
HCPCS G9869
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$100.52 |
| Rate for Payer: Cash Price |
$37.31
|
| Rate for Payer: Cash Price |
$37.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.38
|
| Rate for Payer: Healthfirst QHP |
$38.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.52
|
| Rate for Payer: SOMOS Essential |
$100.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.29
|
|
|
CMMI ASYNTELEHEALTH <10MIN
|
Professional
|
$100.21
|
|
|
Service Code
|
HCPCS G9868
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$75.16 |
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.20
|
| Rate for Payer: Healthfirst QHP |
$28.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.16
|
| Rate for Payer: SOMOS Essential |
$75.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.63
|
|
|
CMMI ASYNTELEHEALTH >20MIN
|
Professional
|
$167.83
|
|
|
Service Code
|
HCPCS G9870
|
| Min. Negotiated Rate |
$33.56 |
| Max. Negotiated Rate |
$125.87 |
| Rate for Payer: Cash Price |
$46.73
|
| Rate for Payer: Cash Price |
$46.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.55
|
| Rate for Payer: Healthfirst QHP |
$47.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.87
|
| Rate for Payer: SOMOS Essential |
$125.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.95
|
|
|
CMPLX RPR F/C/C/M/N/AX 2.6-7.5CM
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
30305559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$726.29
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$327.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| 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 |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
CMPLX RPR F/C/C/M/N/AX 2.6-7.5CM
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13132
|
| Hospital Charge Code |
30105559
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$726.29
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$327.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| 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 |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
CMPTR OPHTH DX IMG ANT SEGMT
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 92132 TC
|
| Hospital Charge Code |
30301451
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.30
|
| Rate for Payer: Aetna Government |
$83.30
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.33
|
| 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 |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.26
|
|
|
CMPTR OPHTH IMG OPTIC NERVE
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 92133 TC
|
| Hospital Charge Code |
30301453
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.30
|
| Rate for Payer: Aetna Government |
$83.30
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.33
|
| 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 |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.26
|
|
|
CMV FEE
|
Facility
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
40701195
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
CMV PCR
|
Facility
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
40619198
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$55.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
CMV QUANT DNA PCR (PLASMA)
|
Facility
OP
|
$107.10
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
40619199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$68.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.84
|
| Rate for Payer: EmblemHealth Commercial |
$42.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$42.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.27
|
| Rate for Payer: Wellcare Medicare |
$38.56
|
|
|
CNTRL POST EPISTAX, INIT
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
30302443
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.18 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: 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: Fidelis CHP/HARP/Medicaid |
$119.12
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$132.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| 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: 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
|
|
|
CNTRL POST EPISTAX, INIT
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
30103270
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.18 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| 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 CHP/HARP/Medicaid |
$119.12
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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 |
$140.33
|
|
|
CO2 CARTRIDGE
|
Facility
OP
|
$100.00
|
|
| Hospital Charge Code |
64907334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.00
|
| Rate for Payer: Aetna Government |
$50.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
CO2 COMBINED
|
Facility
OP
|
$12.20
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
40602075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.88
|
| Rate for Payer: Aetna Government |
$4.88
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.88
|
| Rate for Payer: EmblemHealth Commercial |
$4.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.34
|
| Rate for Payer: Group Health Inc Commercial |
$4.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.88
|
| Rate for Payer: Healthfirst QHP |
$4.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.90
|
| Rate for Payer: Wellcare Medicare |
$4.39
|
|
|
COAGADEX (FACTOR X)
|
Facility
IP
|
$18.18
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
41640377
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.09
|
|
|
COAGADEX (FACTOR X)
|
Facility
IP
|
$18.18
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
41650377
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.09
|
|
|
COAGADEX (FACTOR X)
|
Facility
OP
|
$18.18
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
41640377
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.11
|
| Rate for Payer: Aetna Government |
$9.11
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.11
|
| Rate for Payer: EmblemHealth Commercial |
$9.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.57
|
| Rate for Payer: Group Health Inc Commercial |
$9.11
|
| Rate for Payer: Group Health Inc Medicare |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.75
|
| Rate for Payer: Healthfirst QHP |
$9.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.66
|
| Rate for Payer: SOMOS Essential |
$9.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.29
|
| Rate for Payer: Wellcare Medicare |
$8.66
|
|
