|
DIABETES WITHOUT CC/MCC
|
Facility
IP
|
$16,279.50
|
|
|
Service Code
|
MS-DRG 639
|
| Min. Negotiated Rate |
$5,337.94 |
| Max. Negotiated Rate |
$16,279.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,178.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,960.29
|
| Rate for Payer: Aetna Government |
$15,960.29
|
| Rate for Payer: Brighton Health Commercial |
$9,026.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,279.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10,749.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,871.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,162.28
|
| Rate for Payer: EmblemHealth Commercial |
$5,337.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,960.29
|
| Rate for Payer: Group Health Inc Commercial |
$15,960.29
|
| Rate for Payer: Group Health Inc Medicare |
$15,960.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,960.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,421.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,960.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,960.29
|
| Rate for Payer: Wellcare Medicare |
$15,162.28
|
|
|
DIAB SLF MGMT GROUP 30 MIN
|
Facility
OP
|
$44.78
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
30305423
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.43
|
| Rate for Payer: Aetna Government |
$8.43
|
| Rate for Payer: Amida Care Medicaid |
$20.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,040.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.42
|
| 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 |
$20.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.40
|
| Rate for Payer: Healthfirst Essential Plan |
$45.90
|
| Rate for Payer: Healthfirst QHP |
$20.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.40
|
| Rate for Payer: SOMOS Essential |
$45.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.40
|
|
|
DIAB SLF MGMT INDIVID 30 MIN
|
Facility
OP
|
$161.58
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
30305422
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.61
|
| Rate for Payer: Aetna Government |
$31.61
|
| Rate for Payer: Amida Care Medicaid |
$40.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$129.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$109.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,080.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.84
|
| 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 |
$40.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.80
|
| Rate for Payer: Healthfirst Essential Plan |
$91.80
|
| Rate for Payer: Healthfirst QHP |
$40.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.80
|
| Rate for Payer: SOMOS Essential |
$91.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.80
|
|
|
DIAGNOSTIC ANOSCOPY & BIOPSY
|
Facility
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 46607
|
| Hospital Charge Code |
30306418
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,364.66
|
| Rate for Payer: Aetna Government |
$1,364.66
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,364.66
|
| 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 |
$1,364.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,364.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.55
|
| 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 |
$1,520.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,159.96
|
| Rate for Payer: Healthfirst QHP |
$1,364.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,364.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,364.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,364.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,091.73
|
| Rate for Payer: Wellcare Medicare |
$1,296.43
|
|
|
Diagnostic bone marrow; biopsy(ies)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 38221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
Diagnostic bone marrow; biopsy(ies)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 38221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,874.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
Diagnostic bone marrow; biopsy(ies) and aspiration(s)
|
Facility
OP
|
$3,285.96
|
|
|
Service Code
|
CPT 38222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$3,285.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| 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 |
$3,285.96
|
| Rate for Payer: EmblemHealth Commercial |
$3,285.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,285.96
|
| Rate for Payer: Group Health Inc Medicare |
$3,285.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,793.07
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
Diagnostic bone marrow; biopsy(ies) and aspiration(s)
|
Facility
OP
|
$3,285.96
|
|
|
Service Code
|
CPT 38222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$3,285.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| 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 |
$3,285.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,285.96
|
| Rate for Payer: Group Health Inc Medicare |
$3,285.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,793.07
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
DIAGNOSTIC CASTS
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
HCPCS D0470
|
| Hospital Charge Code |
42300210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.04
|
| Rate for Payer: Aetna Government |
$32.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$42.50
|
| Rate for Payer: Group Health Inc Medicare |
$29.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.50
|
|
|
DIAGNOSTIC LARYNGOSCOPY
|
Facility
OP
|
$474.15
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
30103075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.11 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$229.07
|
| Rate for Payer: Aetna Government |
$229.07
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$229.07
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.07
|
| 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 |
$229.07
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.87
|
| 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 |
$237.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$229.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.26
|
| Rate for Payer: Wellcare Medicare |
$217.62
|
|
|
DIAGNOSTIC LARYNGOSCOPY
|
Facility
OP
|
$474.15
|
|
|
Service Code
|
HCPCS 31505
|
| Hospital Charge Code |
30307796
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.11 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$229.07
|
| Rate for Payer: Aetna Government |
$229.07
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Cash Price |
$229.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.07
|
| 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 |
$229.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.87
|
| 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 |
$237.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.71
|
| Rate for Payer: Healthfirst QHP |
$229.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.26
|
| Rate for Payer: Wellcare Medicare |
$217.62
|
|
|
DIAGNOSTIC MAMMO BILAT INC CAD
|
Facility
OP
|
$502.90
|
|
|
Service Code
|
HCPCS 77066 TC
|
| Hospital Charge Code |
41104721
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$402.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$251.45
|
| Rate for Payer: Aetna Government |
$251.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$402.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$341.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.80
|
| Rate for Payer: Group Health Inc Commercial |
$251.45
|
| Rate for Payer: Group Health Inc Medicare |
$176.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.55
|
|
|
DIAGNOSTIC MAMMO UNI INC CAD
|
Facility
OP
|
$399.85
|
|
|
Service Code
|
HCPCS 77065 TC
|
| Hospital Charge Code |
41104720
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$97.18 |
| Max. Negotiated Rate |
$319.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$199.92
|
| Rate for Payer: Aetna Government |
$199.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.18
|
| Rate for Payer: Group Health Inc Commercial |
$199.92
|
| Rate for Payer: Group Health Inc Medicare |
$139.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.98
|
|
|
DIAGNOSTIC OAE
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 92588 TC
|
| Hospital Charge Code |
42004518
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$6.25 |
| 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 |
$6.25
|
| 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 |
$6.94
|
|
|
DIAGNOSTIC SIGMOIDOSCOPY
|
Facility
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
30300251
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.37 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,056.92
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| 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 |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
DIALTOR WIRE BALLN CRE 8-10MM240C
|
Facility
OP
|
$774.38
|
|
| Hospital Charge Code |
64904300
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$271.03 |
| Max. Negotiated Rate |
$619.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$425.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$387.19
|
| Rate for Payer: Aetna Government |
$387.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$619.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$526.58
|
| Rate for Payer: Group Health Inc Commercial |
$387.19
|
| Rate for Payer: Group Health Inc Medicare |
$271.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$387.19
|
|
|
DIALYSIS MAINTENANCE IN/OUT
|
Facility
OP
|
$1,938.50
|
|
|
Service Code
|
HCPCS 90935
|
| Hospital Charge Code |
42901000
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$1,550.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,066.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$808.11
|
| Rate for Payer: Aetna Government |
$808.11
|
| Rate for Payer: Cash Price |
$808.11
|
| Rate for Payer: Cash Price |
$808.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$808.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,550.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,318.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$808.11
|
| Rate for Payer: EmblemHealth Commercial |
$808.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$719.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$808.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$719.22
|
| Rate for Payer: Group Health Inc Commercial |
$808.11
|
| Rate for Payer: Group Health Inc Medicare |
$808.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$969.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$808.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$686.89
|
| Rate for Payer: Healthfirst QHP |
$808.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$808.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$808.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$646.49
|
| Rate for Payer: Wellcare Medicare |
$767.70
|
|
|
DIALYSIS ONE EVALUATION
|
Facility
OP
|
$1,065.48
|
|
|
Service Code
|
HCPCS 90945
|
| Hospital Charge Code |
42905341
|
|
Hospital Revenue Code
|
831
|
| Min. Negotiated Rate |
$123.10 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$586.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$512.19
|
| Rate for Payer: Aetna Government |
$512.19
|
| Rate for Payer: Amida Care Medicaid |
$123.10
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$512.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$620.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$527.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$512.19
|
| Rate for Payer: EmblemHealth Commercial |
$445.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$512.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.00
|
| Rate for Payer: Group Health Inc Commercial |
$650.00
|
| Rate for Payer: Group Health Inc Medicare |
$435.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$512.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.10
|
| Rate for Payer: Healthfirst Essential Plan |
$276.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$435.36
|
| Rate for Payer: Healthfirst QHP |
$123.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$512.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.10
|
| Rate for Payer: SOMOS Essential |
$276.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$512.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$409.75
|
| Rate for Payer: Wellcare Medicare |
$370.00
|
|
|
DIANEAL 1.5 1LTR BAG
|
Facility
OP
|
$15.95
|
|
| Hospital Charge Code |
42905270
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.98
|
| Rate for Payer: Aetna Government |
$7.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.85
|
| Rate for Payer: Group Health Inc Commercial |
$7.98
|
| Rate for Payer: Group Health Inc Medicare |
$5.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.98
|
|
|
DIANEAL 1.5 2LTR BAG
|
Facility
OP
|
$22.32
|
|
| Hospital Charge Code |
42905280
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.16
|
| Rate for Payer: Aetna Government |
$11.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.18
|
| Rate for Payer: Group Health Inc Commercial |
$11.16
|
| Rate for Payer: Group Health Inc Medicare |
$7.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.16
|
|
|
DIANEAL 1.5 3LTR BAG
|
Facility
OP
|
$29.77
|
|
| Hospital Charge Code |
42905290
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$23.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.88
|
| Rate for Payer: Aetna Government |
$14.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
| Rate for Payer: Group Health Inc Commercial |
$14.88
|
| Rate for Payer: Group Health Inc Medicare |
$10.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.88
|
|
|
DIANEAL 2.5 1LTR BAG
|
Facility
OP
|
$16.31
|
|
| Hospital Charge Code |
42905271
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.16
|
| Rate for Payer: Aetna Government |
$8.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.09
|
| Rate for Payer: Group Health Inc Commercial |
$8.16
|
| Rate for Payer: Group Health Inc Medicare |
$5.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.16
|
|
|
DIANEAL 2.5 2LTR BAG
|
Facility
OP
|
$23.04
|
|
| Hospital Charge Code |
42905281
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.52
|
| Rate for Payer: Aetna Government |
$11.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.67
|
| Rate for Payer: Group Health Inc Commercial |
$11.52
|
| Rate for Payer: Group Health Inc Medicare |
$8.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.52
|
|
|
DIANEAL 2.5 3LTR BAG
|
Facility
OP
|
$30.48
|
|
| Hospital Charge Code |
42905291
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$10.67 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.24
|
| Rate for Payer: Aetna Government |
$15.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.73
|
| Rate for Payer: Group Health Inc Commercial |
$15.24
|
| Rate for Payer: Group Health Inc Medicare |
$10.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.24
|
|
|
DIANEAL 4.25 1LTR BAG
|
Facility
OP
|
$16.65
|
|
| Hospital Charge Code |
42905272
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$13.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.32
|
| Rate for Payer: Aetna Government |
$8.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.32
|
| Rate for Payer: Group Health Inc Commercial |
$8.32
|
| Rate for Payer: Group Health Inc Medicare |
$5.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.32
|
|
