|
COMP KNEE FEMRL POR SZ-G RGT
|
Facility
OP
|
$10,467.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$10,991.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,757.26
|
| 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 |
$5,233.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,018.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,991.14
|
| Rate for Payer: Group Health Inc Commercial |
$5,233.88
|
| Rate for Payer: Group Health Inc Medicare |
$3,663.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,233.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,233.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,804.04
|
|
|
COMP KNEE FEMRL POR SZ-G RGT
|
Facility
IP
|
$10,467.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64902519
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,233.88 |
| Max. Negotiated Rate |
$5,233.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,233.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,233.88
|
|
|
COMPLEMENT C1Q, QUANTITATIVE
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
40609139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.60
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
COMPLEMENT C3, SERUM
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
40609136
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.60
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
COMPLEMENT C4, SERUM
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
40609137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.60
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
COMPLEMENT, TOTAL (CH50)
|
Facility
OP
|
$50.80
|
|
|
Service Code
|
HCPCS 86162
|
| Hospital Charge Code |
40609140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$32.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.32
|
| Rate for Payer: Aetna Government |
$20.32
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Cash Price |
$20.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.32
|
| Rate for Payer: EmblemHealth Commercial |
$20.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.08
|
| Rate for Payer: Group Health Inc Commercial |
$20.32
|
| Rate for Payer: Group Health Inc Medicare |
$20.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.32
|
| Rate for Payer: Healthfirst QHP |
$20.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.26
|
| Rate for Payer: Wellcare Medicare |
$18.29
|
|
|
COMPLETE AUDIO- PTT & SPEECH AUDI
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 92557
|
| Hospital Charge Code |
42003115
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$32.56 |
| 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 |
$32.56
|
| 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 |
$36.18
|
| 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
|
|
|
COMPLETE LOWER DENTURE
|
Facility
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS D5120
|
| Hospital Charge Code |
42300965
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.71 |
| Max. Negotiated Rate |
$28,571.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$770.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.84
|
| Rate for Payer: Aetna Government |
$402.84
|
| Rate for Payer: Amida Care Medicaid |
$285.71
|
| 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: Fidelis CHP/HARP/Medicaid |
$28,571.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$285.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$300.00
|
| Rate for Payer: Group Health Inc Commercial |
$700.00
|
| Rate for Payer: Group Health Inc Medicare |
$490.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.71
|
| Rate for Payer: Healthfirst Essential Plan |
$642.85
|
| Rate for Payer: Healthfirst QHP |
$285.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$285.71
|
| Rate for Payer: SOMOS Essential |
$642.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$285.71
|
|
|
COMPLETE STUDY W/BRONCHDIALAIR
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94070 TC
|
| Hospital Charge Code |
40402400
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
| Rate for Payer: Aetna Government |
$383.29
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.66
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.85
|
|
|
COMPLETE ULTRASOUND OF JOINT
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76881
|
| Hospital Charge Code |
30100126
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
COMPLETE UPPER DENTURE
|
Facility
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS D5110
|
| Hospital Charge Code |
42300960
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.71 |
| Max. Negotiated Rate |
$28,571.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$770.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.84
|
| Rate for Payer: Aetna Government |
$402.84
|
| Rate for Payer: Amida Care Medicaid |
$285.71
|
| 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: Fidelis CHP/HARP/Medicaid |
$28,571.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$285.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$300.00
|
| Rate for Payer: Group Health Inc Commercial |
$700.00
|
| Rate for Payer: Group Health Inc Medicare |
$490.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$285.71
|
| Rate for Payer: Healthfirst Essential Plan |
$642.85
|
| Rate for Payer: Healthfirst QHP |
$285.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$285.71
|
| Rate for Payer: SOMOS Essential |
$642.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$285.71
|
|
|
COMPLEX CYSTOMETROGRAM
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 51726 TC
|
| Hospital Charge Code |
30300029
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$391.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$355.72
|
| Rate for Payer: Aetna Government |
$355.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| 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: Fidelis CHP/HARP/Medicaid |
$242.78
|
| 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 |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.76
|
|
|
COMPLEX CYSTOMETROGRAM
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 51726 TC
|
| Hospital Charge Code |
40122909
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$242.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$391.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$355.72
|
| Rate for Payer: Aetna Government |
$355.72
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| 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 |
$242.78
|
| Rate for Payer: Group Health Inc Commercial |
$355.72
|
| Rate for Payer: Group Health Inc Medicare |
$249.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.76
|
|
|
COMPLEX E/M VISIT ADD ON
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2211
|
| Hospital Charge Code |
30300339
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COMPLEX UROFLOWMETRY
|
Facility
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 51741 TC
|
| Hospital Charge Code |
30302040
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$2,915.00 |
| 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: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| 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: Fidelis CHP/HARP/Medicaid |
$6.62
|
| 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 |
$210.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.35
|
|
|
COMPLEX UROFLOWMETRY/ELECTRO
|
Facility
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 51741 TC
|
| Hospital Charge Code |
40129710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$2,915.00 |
| 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 |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| 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 |
$6.62
|
| 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 |
$7.35
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
IP
|
$22,651.70
|
|
|
Service Code
|
MS-DRG 381
|
| Min. Negotiated Rate |
$9,200.98 |
| Max. Negotiated Rate |
$22,651.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,821.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,207.55
|
| Rate for Payer: Aetna Government |
$22,207.55
|
| Rate for Payer: Brighton Health Commercial |
$15,558.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,651.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,529.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,291.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,097.17
|
| Rate for Payer: EmblemHealth Commercial |
$9,200.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,207.55
|
| Rate for Payer: Group Health Inc Commercial |
$22,207.55
|
| Rate for Payer: Group Health Inc Medicare |
$22,207.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,207.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,326.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,207.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,207.55
|
| Rate for Payer: Wellcare Medicare |
$21,097.17
|
|
|
COMPLICATED PEPTIC ULCER WITH MCC
|
Facility
IP
|
$35,035.41
|
|
|
Service Code
|
MS-DRG 380
|
| Min. Negotiated Rate |
$15,972.02 |
| Max. Negotiated Rate |
$35,035.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28,730.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,348.44
|
| Rate for Payer: Aetna Government |
$34,348.44
|
| Rate for Payer: Brighton Health Commercial |
$28,253.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,035.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33,648.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27,768.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,631.02
|
| Rate for Payer: EmblemHealth Commercial |
$16,708.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,348.44
|
| Rate for Payer: Group Health Inc Commercial |
$34,348.44
|
| Rate for Payer: Group Health Inc Medicare |
$34,348.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,348.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,972.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,348.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,348.44
|
| Rate for Payer: Wellcare Medicare |
$32,631.02
|
|
|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
IP
|
$18,183.38
|
|
|
Service Code
|
MS-DRG 382
|
| Min. Negotiated Rate |
$6,492.13 |
| Max. Negotiated Rate |
$18,183.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,163.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,826.84
|
| Rate for Payer: Aetna Government |
$17,826.84
|
| Rate for Payer: Brighton Health Commercial |
$10,977.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,183.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,074.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,789.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,935.50
|
| Rate for Payer: EmblemHealth Commercial |
$6,492.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,826.84
|
| Rate for Payer: Group Health Inc Commercial |
$17,826.84
|
| Rate for Payer: Group Health Inc Medicare |
$17,826.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,826.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,289.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,826.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,826.84
|
| Rate for Payer: Wellcare Medicare |
$16,935.50
|
|
|
COMPLICATED SUTURE > 5 CM, METICU
|
Facility
OP
|
$2,268.00
|
|
|
Service Code
|
HCPCS D7912
|
| Hospital Charge Code |
42302050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,247.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$541.31
|
| Rate for Payer: Aetna Government |
$541.31
|
| Rate for Payer: Amida Care Medicaid |
$97.60
|
| 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: Fidelis CHP/HARP/Medicaid |
$9,760.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.48
|
| Rate for Payer: Group Health Inc Commercial |
$1,134.00
|
| Rate for Payer: Group Health Inc Medicare |
$793.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,134.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.60
|
| Rate for Payer: Healthfirst Essential Plan |
$219.60
|
| Rate for Payer: Healthfirst QHP |
$97.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.60
|
| Rate for Payer: SOMOS Essential |
$219.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$97.60
|
|
|
COMPLICATED SUTURE UP TO 5 CM,MET
|
Facility
OP
|
$312.50
|
|
|
Service Code
|
HCPCS D7911
|
| Hospital Charge Code |
42302045
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.68
|
| Rate for Payer: Aetna Government |
$300.68
|
| Rate for Payer: Amida Care Medicaid |
$97.60
|
| 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: Fidelis CHP/HARP/Medicaid |
$9,760.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.48
|
| Rate for Payer: Group Health Inc Commercial |
$156.25
|
| Rate for Payer: Group Health Inc Medicare |
$109.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.60
|
| Rate for Payer: Healthfirst Essential Plan |
$219.60
|
| Rate for Payer: Healthfirst QHP |
$97.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.60
|
| Rate for Payer: SOMOS Essential |
$219.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$97.60
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
IP
|
$22,097.22
|
|
|
Service Code
|
MS-DRG 920
|
| Min. Negotiated Rate |
$8,864.84 |
| Max. Negotiated Rate |
$22,097.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,243.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,663.94
|
| Rate for Payer: Aetna Government |
$21,663.94
|
| Rate for Payer: Brighton Health Commercial |
$14,990.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,097.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,852.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,732.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,580.74
|
| Rate for Payer: EmblemHealth Commercial |
$8,864.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,663.94
|
| Rate for Payer: Group Health Inc Commercial |
$21,663.94
|
| Rate for Payer: Group Health Inc Medicare |
$21,663.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,663.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,073.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,663.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,663.94
|
| Rate for Payer: Wellcare Medicare |
$20,580.74
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
IP
|
$33,284.30
|
|
|
Service Code
|
MS-DRG 919
|
| Min. Negotiated Rate |
$15,173.73 |
| Max. Negotiated Rate |
$33,284.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,905.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,631.67
|
| Rate for Payer: Aetna Government |
$32,631.67
|
| Rate for Payer: Brighton Health Commercial |
$26,458.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,284.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,510.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,004.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,000.09
|
| Rate for Payer: EmblemHealth Commercial |
$15,646.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,631.67
|
| Rate for Payer: Group Health Inc Commercial |
$32,631.67
|
| Rate for Payer: Group Health Inc Medicare |
$32,631.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,631.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,173.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,631.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,631.67
|
| Rate for Payer: Wellcare Medicare |
$31,000.09
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
IP
|
$17,344.59
|
|
|
Service Code
|
MS-DRG 921
|
| Min. Negotiated Rate |
$5,983.64 |
| Max. Negotiated Rate |
$17,344.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,289.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,004.50
|
| Rate for Payer: Aetna Government |
$17,004.50
|
| Rate for Payer: Brighton Health Commercial |
$10,118.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,344.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,050.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,944.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,154.28
|
| Rate for Payer: EmblemHealth Commercial |
$5,983.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,004.50
|
| Rate for Payer: Group Health Inc Commercial |
$17,004.50
|
| Rate for Payer: Group Health Inc Medicare |
$17,004.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,004.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,907.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,004.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,004.50
|
| Rate for Payer: Wellcare Medicare |
$16,154.28
|
|
|
COMPLX REPAIR FACE,EXT,GEN ADD5CM
|
Facility
OP
|
$752.68
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
30105182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.36 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.36
|
| Rate for Payer: Aetna Government |
$114.36
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| 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: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.99
|
| 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 |
$376.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
