|
ACETYLCYSTEINE 20% SOLN 4 ML
|
Facility
OP
|
$1.54
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41653441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.77
|
| Rate for Payer: Group Health Inc Medicare |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.00
|
|
|
ACETYLCYSTEINE 20% SOLN 4 ML
|
Facility
IP
|
$1.54
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41643441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.77
|
|
|
ACETYLCYSTEINE 20% SOLN 4 ML
|
Facility
OP
|
$1.54
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41643441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$9.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.08
|
| Rate for Payer: Aetna Government |
$6.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.77
|
| Rate for Payer: Group Health Inc Medicare |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.92
|
| Rate for Payer: SOMOS Essential |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.00
|
|
|
ACETYLCYSTEINE 20% SOLN 4 ML
|
Facility
IP
|
$1.54
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
41653441
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.77
|
|
|
ACHR BINDING ABS, SERUM
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 83519
|
| Hospital Charge Code |
40609089
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.40
|
| Rate for Payer: Aetna Government |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.40
|
| Rate for Payer: EmblemHealth Commercial |
$18.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.38
|
| Rate for Payer: Group Health Inc Commercial |
$18.40
|
| Rate for Payer: Group Health Inc Medicare |
$18.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.40
|
| Rate for Payer: Healthfirst QHP |
$18.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.72
|
| Rate for Payer: Wellcare Medicare |
$16.56
|
|
|
ACID ACETIC CONCENTRATE 45X
|
Facility
OP
|
$8.28
|
|
| Hospital Charge Code |
64902070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.14
|
| Rate for Payer: Aetna Government |
$4.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.63
|
| Rate for Payer: Group Health Inc Commercial |
$4.14
|
| Rate for Payer: Group Health Inc Medicare |
$2.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.14
|
|
|
ACL REPAIR KNEE
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 27409
|
| Hospital Charge Code |
40014305
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.49 |
| Max. Negotiated Rate |
$9,058.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,101.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,223.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
ACL TIGHTROPE RT
|
Facility
OP
|
$875.00
|
|
| Hospital Charge Code |
64905350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$481.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$437.50
|
| Rate for Payer: Aetna Government |
$437.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$700.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$595.00
|
| Rate for Payer: Group Health Inc Commercial |
$437.50
|
| Rate for Payer: Group Health Inc Medicare |
$306.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$437.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$437.50
|
|
|
ACMI VACUR 12MM CURVED CURRETTE
|
Facility
OP
|
$94.00
|
|
| Hospital Charge Code |
40200465
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$75.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.00
|
| Rate for Payer: Aetna Government |
$47.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$75.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.92
|
| Rate for Payer: Group Health Inc Commercial |
$47.00
|
| Rate for Payer: Group Health Inc Medicare |
$32.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.00
|
|
|
ACMI VACUR 14MM CURVED CURRETTE
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
40200466
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
|
|
ACNE SURGERY
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
42201300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.94 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.94 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
ACOUSTIC IMMITTANCE TESTING
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 92570
|
| Hospital Charge Code |
42003105
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| 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 |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.84
|
| 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 |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Senior Whole Health 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
|
|
|
ACOUSTIC REFLEX TESTING
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 92568
|
| Hospital Charge Code |
42003000
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.38
|
| Rate for Payer: Aetna Government |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.38
|
| Rate for Payer: EmblemHealth Commercial |
$46.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Group Health Inc Commercial |
$46.38
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.42
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Wellcare Medicare |
$44.06
|
|
|
ACP DISCUS/DSCN MKR DOCD
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 1123F
|
| Hospital Charge Code |
30306661
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| 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 |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
ACROMIOPLASTY SHOULDER
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 23130
|
| Hospital Charge Code |
40029801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$706.72 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| 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 CHP/HARP/Medicaid |
$706.72
|
| 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 CHP/FHP/Medicaid |
$785.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health 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
|
|
|
ACTBLR SHELL 52MM/POR COATED,LTDH
|
Facility
OP
|
$3,360.00
|
|
| Hospital Charge Code |
40202079
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,176.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,848.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,680.00
|
| Rate for Payer: Aetna Government |
$1,680.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,688.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,284.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,680.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,176.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,680.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,680.00
|
|
|
ACTBLR SHELL 54MM/POR COATED,LTDH
|
Facility
OP
|
$3,360.00
|
|
| Hospital Charge Code |
40202085
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,176.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,848.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,680.00
|
| Rate for Payer: Aetna Government |
$1,680.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,688.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,284.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,680.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,176.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,680.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,680.00
|
|
|
ACTBLR SHELL 58MM/PORO CTD,LTD HL
|
Facility
OP
|
$3,360.00
|
|
| Hospital Charge Code |
40209409
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,176.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,848.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,680.00
|
| Rate for Payer: Aetna Government |
$1,680.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,688.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,284.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,680.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,176.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,680.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,680.00
|
|
|
ACTH, PLASMA
|
Facility
OP
|
$96.55
|
|
|
Service Code
|
HCPCS 82024
|
| Hospital Charge Code |
40609032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$61.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.62
|
| Rate for Payer: Aetna Government |
$38.62
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Cash Price |
$38.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$61.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.62
|
| Rate for Payer: EmblemHealth Commercial |
$38.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.37
|
| Rate for Payer: Group Health Inc Commercial |
$38.62
|
| Rate for Payer: Group Health Inc Medicare |
$38.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.62
|
| Rate for Payer: Healthfirst QHP |
$38.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.90
|
| Rate for Payer: Wellcare Medicare |
$34.76
|
|
|
ACTIN (SMOOTH MUSCLE) ANTIBODY
|
Facility
OP
|
$28.83
|
|
|
Service Code
|
HCPCS 83516
|
| Hospital Charge Code |
40729238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.22
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
ACTIVE ARTICULATION E1
|
Facility
OP
|
$6,130.00
|
|
| Hospital Charge Code |
64905571
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,145.50 |
| Max. Negotiated Rate |
$4,904.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,371.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,065.00
|
| Rate for Payer: Aetna Government |
$3,065.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,904.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,168.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,065.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,145.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,065.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,065.00
|
|
|
ACUMED 10MM MICRO ACUTRAK 2 B/S
|
Facility
IP
|
$1,046.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40206233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.00 |
| Max. Negotiated Rate |
$523.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$523.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$523.00
|
|
|
ACUMED 10MM MICRO ACUTRAK 2 B/S
|
Facility
OP
|
$1,046.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40206233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,098.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$575.30
|
| 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 |
$523.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,098.30
|
| Rate for Payer: Group Health Inc Commercial |
$523.00
|
| Rate for Payer: Group Health Inc Medicare |
$366.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$523.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$523.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$679.90
|
|
|
ACUMED ACTK FIX SYS 20.0MM/2 B/S
|
Facility
IP
|
$916.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205414
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.00 |
| Max. Negotiated Rate |
$458.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$458.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$458.00
|
|
