|
Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 56501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
|
Facility
OP
|
$3,615.39
|
|
|
Service Code
|
CPT 57061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$129.80 |
| Max. Negotiated Rate |
$3,615.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
DESTRUCTION PENIS LESION
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
40129401
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
DESTRUCTION PENIS LESION
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 54055
|
| Hospital Charge Code |
30302450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| 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 |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
DESTRUCT LESION 15 OR MORE
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
40019931
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$89.29 |
| 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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.29
|
| 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 |
$99.21
|
| 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
|
|
|
DESTRUCT LESION 15 OR MORE
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
30302446
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.29 |
| 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: Brighton Health Commercial |
$233.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$89.29
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$99.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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
|
|
|
DETAILED & EXTENSIVE ORAL EVAL.
|
Facility
OP
|
$106.31
|
|
|
Service Code
|
HCPCS D0160
|
| Hospital Charge Code |
42303273
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$152.87
|
| Rate for Payer: Aetna Government |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.87
|
| 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 |
$152.87
|
| Rate for Payer: EmblemHealth Commercial |
$152.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.05
|
| Rate for Payer: Group Health Inc Commercial |
$152.87
|
| Rate for Payer: Group Health Inc Medicare |
$152.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.94
|
| Rate for Payer: Healthfirst QHP |
$152.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$122.30
|
| Rate for Payer: Wellcare Medicare |
$145.23
|
|
|
DETECTOR CO2 PED END-TIDAL 6/CS
|
Facility
OP
|
$11.25
|
|
| Hospital Charge Code |
64903273
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.62
|
| Rate for Payer: Aetna Government |
$5.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.62
|
| Rate for Payer: Group Health Inc Medicare |
$3.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.62
|
|
|
DETECTOR,EASY CAP II,CO2
|
Facility
OP
|
$22.50
|
|
| Hospital Charge Code |
64902572
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.25
|
| Rate for Payer: Aetna Government |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.30
|
| Rate for Payer: Group Health Inc Commercial |
$11.25
|
| Rate for Payer: Group Health Inc Medicare |
$7.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.25
|
|
|
DETORSION TESTICLE
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
30107556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$4,571.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$4,031.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| 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 |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$489.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| 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 |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
DETORSION TESTICLE
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
40123105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$489.73 |
| Max. Negotiated Rate |
$4,571.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| 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 |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$489.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$544.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
DEVELOPER TYPE S 1/4 GAL 3-7-90
|
Facility
OP
|
$67.79
|
|
| Hospital Charge Code |
64902311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$54.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.90
|
| Rate for Payer: Aetna Government |
$33.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$54.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.10
|
| Rate for Payer: Group Health Inc Commercial |
$33.90
|
| Rate for Payer: Group Health Inc Medicare |
$23.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.90
|
|
|
DEVELOPMENTAL SCREEN W/SCORE
|
Facility
OP
|
$797.35
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
30306633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$438.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$438.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
| Rate for Payer: Aetna Government |
$8.11
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$398.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.68
|
|
|
DEVELOPMENTAL TESTING, PER HR
|
Facility
OP
|
$318.94
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
41904868
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$175.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.11
|
| Rate for Payer: Aetna Government |
$8.11
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$159.47
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$159.47
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
DEVEL TST PHYS/QHP 1ST HR
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 96112
|
| Hospital Charge Code |
30307921
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$144.51 |
| Max. Negotiated Rate |
$17,410.00 |
| 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: Amida Care Medicaid |
$174.10
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$175.69
|
| 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 |
$17,410.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.80
|
| 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 |
$174.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.10
|
| Rate for Payer: Healthfirst Essential Plan |
$391.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$174.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$395.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$395.30
|
| Rate for Payer: Optum Medicaid |
$175.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.10
|
| Rate for Payer: SOMOS Essential |
$391.72
|
| 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
|
|
|
DEVEL TST PHYS/QHP EA ADDL
|
Facility
OP
|
$169.50
|
|
|
Service Code
|
HCPCS 96113
|
| Hospital Charge Code |
30307922
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$50.09 |
| Max. Negotiated Rate |
$9,674.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Government |
$50.09
|
| Rate for Payer: Amida Care Medicaid |
$96.74
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$97.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9,674.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.58
|
| Rate for Payer: Group Health Inc Commercial |
$84.75
|
| Rate for Payer: Group Health Inc Medicare |
$59.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.74
|
| Rate for Payer: Healthfirst Essential Plan |
$217.66
|
| Rate for Payer: Healthfirst QHP |
$96.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.64
|
| Rate for Payer: Optum Medicaid |
$97.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.74
|
| Rate for Payer: SOMOS Essential |
$217.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$96.74
|
|
|
DEVICE ACCES LUER MALE
|
Facility
OP
|
$1.44
|
|
| Hospital Charge Code |
64901900
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.72
|
| Rate for Payer: Aetna Government |
$0.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.98
|
| Rate for Payer: Group Health Inc Commercial |
$0.72
|
| Rate for Payer: Group Health Inc Medicare |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.72
|
|
|
DEVICE BLOOD TRANSFER A
|
Facility
OP
|
$1.48
|
|
| Hospital Charge Code |
64901630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.74
|
| Rate for Payer: Aetna Government |
$0.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.74
|
| Rate for Payer: Group Health Inc Medicare |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.74
|
|
|
DEVICE BLOOD TRANSFER B
|
Facility
OP
|
$1.61
|
|
| Hospital Charge Code |
64902528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.81
|
| Rate for Payer: Aetna Government |
$0.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.81
|
| Rate for Payer: Group Health Inc Medicare |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.81
|
|
|
DEVICE BONE BIOPSY TPRD SZ2KYPHON
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
64904842
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$175.00
|
| Rate for Payer: Aetna Government |
$175.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
|
|
DEVICE BSKT DK RTV 1.9F,8MM
|
Facility
OP
|
$584.64
|
|
| Hospital Charge Code |
64906728
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$204.62 |
| Max. Negotiated Rate |
$467.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$321.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$292.32
|
| Rate for Payer: Aetna Government |
$292.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$467.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$397.56
|
| Rate for Payer: Group Health Inc Commercial |
$292.32
|
| Rate for Payer: Group Health Inc Medicare |
$204.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$292.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$292.32
|
|
|
DEVICE CLIPPING HEMOSTATIC 155CM
|
Facility
OP
|
$317.42
|
|
| Hospital Charge Code |
64904294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$111.10 |
| Max. Negotiated Rate |
$253.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$158.71
|
| Rate for Payer: Aetna Government |
$158.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$253.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$215.85
|
| Rate for Payer: Group Health Inc Commercial |
$158.71
|
| Rate for Payer: Group Health Inc Medicare |
$111.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.71
|
|
|
DEVICE CLIPPING HEMOSTATIC 235CM
|
Facility
OP
|
$634.84
|
|
| Hospital Charge Code |
64904296
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.19 |
| Max. Negotiated Rate |
$507.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$349.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$317.42
|
| Rate for Payer: Aetna Government |
$317.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$507.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$431.69
|
| Rate for Payer: Group Health Inc Commercial |
$317.42
|
| Rate for Payer: Group Health Inc Medicare |
$222.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$317.42
|
|
|
DEVICE CLIPPING HEMOSTATIC 235CM
|
Facility
OP
|
$498.00
|
|
| Hospital Charge Code |
40209789
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$174.30 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$273.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$249.00
|
| Rate for Payer: Aetna Government |
$249.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$398.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$338.64
|
| Rate for Payer: Group Health Inc Commercial |
$249.00
|
| Rate for Payer: Group Health Inc Medicare |
$174.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$249.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$249.00
|
|
|
DEVICE CLIP ROTATABLE 230CM 2.8MM
|
Facility
OP
|
$158.18
|
|
| Hospital Charge Code |
64904302
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.36 |
| Max. Negotiated Rate |
$126.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$87.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.09
|
| Rate for Payer: Aetna Government |
$79.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$126.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$107.56
|
| Rate for Payer: Group Health Inc Commercial |
$79.09
|
| Rate for Payer: Group Health Inc Medicare |
$55.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.09
|
|
