|
CORD BLOOD GAS,ARTERIAL
|
Facility
OP
|
$65.18
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
40602312
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
CORD BLOOD GAS, VENOUS
|
Facility
OP
|
$65.18
|
|
|
Service Code
|
HCPCS 82803
|
| Hospital Charge Code |
40602313
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$35.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.07
|
| Rate for Payer: Aetna Government |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.07
|
| Rate for Payer: EmblemHealth Commercial |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.20
|
| Rate for Payer: Group Health Inc Commercial |
$26.07
|
| Rate for Payer: Group Health Inc Medicare |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.07
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Wellcare Medicare |
$23.46
|
|
|
CORD BLOOD RPR
|
Facility
OP
|
$10.68
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
40721423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.27
|
| Rate for Payer: EmblemHealth Commercial |
$4.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.27
|
| Rate for Payer: Healthfirst QHP |
$4.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.42
|
| Rate for Payer: Wellcare Medicare |
$3.84
|
|
|
CORD BUCKS TRACTION
|
Facility
OP
|
$232.50
|
|
| Hospital Charge Code |
64904101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.38 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$127.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$116.25
|
| Rate for Payer: Aetna Government |
$116.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$186.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$158.10
|
| Rate for Payer: Group Health Inc Commercial |
$116.25
|
| Rate for Payer: Group Health Inc Medicare |
$81.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.25
|
|
|
CORDIS FILTER VENA CAVA PRM TRAPE
|
Facility
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
40209930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.00
|
|
|
CORDIS FILTER VENA CAVA PRM TRAPE
|
Facility
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
40209930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,320.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.08
|
| Rate for Payer: Aetna Government |
$57.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,380.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,520.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,200.00
|
| Rate for Payer: Group Health Inc Medicare |
$840.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,200.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,560.00
|
|
|
COR DISPOSABLE SET SZ 6MM
|
Facility
OP
|
$1,890.00
|
|
| Hospital Charge Code |
40209620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,039.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$945.00
|
| Rate for Payer: Aetna Government |
$945.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,512.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,285.20
|
| Rate for Payer: Group Health Inc Commercial |
$945.00
|
| Rate for Payer: Group Health Inc Medicare |
$661.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$945.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$945.00
|
|
|
COR DISPOSABLE SET SZ 8MM
|
Facility
OP
|
$1,576.00
|
|
| Hospital Charge Code |
40209621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$551.60 |
| Max. Negotiated Rate |
$1,260.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$866.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$788.00
|
| Rate for Payer: Aetna Government |
$788.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,260.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,071.68
|
| Rate for Payer: Group Health Inc Commercial |
$788.00
|
| Rate for Payer: Group Health Inc Medicare |
$551.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$788.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$788.00
|
|
|
CORD MONOPOLAR W/8MM PLUG
|
Facility
OP
|
$68.50
|
|
| Hospital Charge Code |
64905020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$54.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.25
|
| Rate for Payer: Aetna Government |
$34.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.58
|
| Rate for Payer: Group Health Inc Commercial |
$34.25
|
| Rate for Payer: Group Health Inc Medicare |
$23.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.25
|
|
|
CORE BUILD-UP, INCLUDING ANY PINS
|
Facility
OP
|
$354.38
|
|
|
Service Code
|
HCPCS D2950
|
| Hospital Charge Code |
42300645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.19 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$194.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
CORNEA IMPLANT
|
Facility
OP
|
$2,354.08
|
|
| Hospital Charge Code |
40202050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$823.93 |
| Max. Negotiated Rate |
$1,883.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,294.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,177.04
|
| Rate for Payer: Aetna Government |
$1,177.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,883.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,600.77
|
| Rate for Payer: Group Health Inc Commercial |
$1,177.04
|
| Rate for Payer: Group Health Inc Medicare |
$823.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,177.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,177.04
|
|
|
CORNEAL FB,REMOVAL W/O SLIT LAMP
|
Facility
OP
|
$1,101.23
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
30301991
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.42 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$460.76
|
| Rate for Payer: Aetna Government |
$460.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$460.76
|
| 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 |
$460.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$460.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.08
|
| 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 |
$550.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.65
|
| Rate for Payer: Healthfirst QHP |
$460.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$460.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$460.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$460.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.61
|
| Rate for Payer: Wellcare Medicare |
$437.72
|
|
|
CORNEAL FB, REMOVAL W/SLIT LAMP
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
30301998
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.68 |
| 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: 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 |
$51.68
|
| 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 |
$57.42
|
| 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
|
|
|
CORNEAL TRANSPLANT
|
Facility
OP
|
$11,564.78
|
|
|
Service Code
|
HCPCS 65710
|
| Hospital Charge Code |
40072480
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,212.16 |
| Max. Negotiated Rate |
$6,044.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,044.08
|
| Rate for Payer: Aetna Government |
$6,044.08
|
| Rate for Payer: Cash Price |
$6,044.08
|
| Rate for Payer: Cash Price |
$6,044.08
|
| Rate for Payer: Cash Price |
$6,044.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,044.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,044.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,212.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,137.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,379.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,044.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,379.23
|
| Rate for Payer: Group Health Inc Commercial |
$6,044.08
|
| Rate for Payer: Group Health Inc Medicare |
$6,044.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,782.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,044.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,346.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,137.47
|
| Rate for Payer: Healthfirst QHP |
$6,044.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,044.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,044.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,835.26
|
| Rate for Payer: Wellcare Medicare |
$5,741.88
|
|
|
CORNEA TRANSPLANT BILATERAL
|
Facility
OP
|
$11,564.78
|
|
|
Service Code
|
HCPCS 65750
|
| Hospital Charge Code |
40209554
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,334.82 |
| Max. Negotiated Rate |
$6,044.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,044.08
|
| Rate for Payer: Aetna Government |
$6,044.08
|
| Rate for Payer: Cash Price |
$6,044.08
|
| Rate for Payer: Cash Price |
$6,044.08
|
| Rate for Payer: Cash Price |
$6,044.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,044.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,044.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,334.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,137.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,379.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,044.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,379.23
|
| Rate for Payer: Group Health Inc Commercial |
$6,044.08
|
| Rate for Payer: Group Health Inc Medicare |
$6,044.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,782.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,044.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,483.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,137.47
|
| Rate for Payer: Healthfirst QHP |
$6,044.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,044.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,044.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,835.26
|
| Rate for Payer: Wellcare Medicare |
$5,741.88
|
|
|
CORNEA TRANSPLANT UNILATERAL
|
Facility
OP
|
$11,564.78
|
|
|
Service Code
|
HCPCS 65750
|
| Hospital Charge Code |
40209553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,334.82 |
| Max. Negotiated Rate |
$6,044.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,044.08
|
| Rate for Payer: Aetna Government |
$6,044.08
|
| Rate for Payer: Cash Price |
$6,044.08
|
| Rate for Payer: Cash Price |
$6,044.08
|
| Rate for Payer: Cash Price |
$6,044.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,044.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,044.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,334.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,137.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,379.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,044.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,379.23
|
| Rate for Payer: Group Health Inc Commercial |
$6,044.08
|
| Rate for Payer: Group Health Inc Medicare |
$6,044.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,782.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,044.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,483.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,137.47
|
| Rate for Payer: Healthfirst QHP |
$6,044.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,044.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,044.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,835.26
|
| Rate for Payer: Wellcare Medicare |
$5,741.88
|
|
|
COROENT LC 12X11X25 8 DEG
|
Facility
OP
|
$9,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$9,828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,148.00
|
| 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 |
$4,680.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,382.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,828.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,680.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,276.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,680.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,680.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,084.00
|
|
|
COROENT LC 12X11X25 8 DEG
|
Facility
IP
|
$9,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,680.00 |
| Max. Negotiated Rate |
$4,680.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,680.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,680.00
|
|
|
COROENT LC, 12X9X25 8
|
Facility
IP
|
$9,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,680.00 |
| Max. Negotiated Rate |
$4,680.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,680.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,680.00
|
|
|
COROENT LC, 12X9X25 8
|
Facility
OP
|
$9,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905586
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$9,828.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,148.00
|
| 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 |
$4,680.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,382.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,828.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,680.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,276.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,680.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,680.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,084.00
|
|
|
COROENT LI, 10X11X26MM 4D
|
Facility
IP
|
$8,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,490.00 |
| Max. Negotiated Rate |
$4,490.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,490.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,490.00
|
|
|
COROENT LI, 10X11X26MM 4D
|
Facility
OP
|
$8,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905419
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$9,429.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,939.00
|
| 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 |
$4,490.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,163.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,429.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,490.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,143.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,490.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,490.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,837.00
|
|
|
COROENT LI 12X9X20MM 4 DEG
|
Facility
OP
|
$19,760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$20,748.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,868.00
|
| 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 |
$9,880.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,362.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,748.00
|
| Rate for Payer: Group Health Inc Commercial |
$9,880.00
|
| Rate for Payer: Group Health Inc Medicare |
$6,916.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,880.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,880.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,844.00
|
|
|
COROENT LI 12X9X20MM 4 DEG
|
Facility
IP
|
$19,760.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,880.00 |
| Max. Negotiated Rate |
$9,880.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,880.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,880.00
|
|
|
COROENT LI 2X11X26MM 4 DEG
|
Facility
IP
|
$8,237.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,118.75 |
| Max. Negotiated Rate |
$4,118.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,118.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,118.75
|
|
