|
AFFIXUS INSTRUMENT CASE 2
|
Facility
IP
|
$4,512.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,256.00 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,256.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,256.00
|
|
|
AFLURIA SYRINGE
|
Facility
OP
|
$24.90
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
41647080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$1,267.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.69
|
| Rate for Payer: Aetna Government |
$17.69
|
| Rate for Payer: Amida Care Medicaid |
$12.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,267.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.30
|
| Rate for Payer: Group Health Inc Commercial |
$12.45
|
| Rate for Payer: Group Health Inc Medicare |
$8.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.67
|
| Rate for Payer: Healthfirst Essential Plan |
$12.67
|
| Rate for Payer: Healthfirst QHP |
$12.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.67
|
| Rate for Payer: SOMOS Essential |
$12.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.67
|
|
|
AFLURIA SYRINGE
|
Facility
OP
|
$24.90
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
41657080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$1,267.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.69
|
| Rate for Payer: Aetna Government |
$17.69
|
| Rate for Payer: Amida Care Medicaid |
$12.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,267.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.30
|
| Rate for Payer: Group Health Inc Commercial |
$12.45
|
| Rate for Payer: Group Health Inc Medicare |
$8.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.67
|
| Rate for Payer: Healthfirst Essential Plan |
$12.67
|
| Rate for Payer: Healthfirst QHP |
$12.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.67
|
| Rate for Payer: SOMOS Essential |
$12.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.67
|
|
|
AFLURIA SYRINGE
|
Facility
IP
|
$24.90
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
41657080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.45
|
|
|
AFLURIA SYRINGE
|
Facility
IP
|
$24.90
|
|
|
Service Code
|
HCPCS 90656
|
| Hospital Charge Code |
41647080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.45
|
|
|
AFP, SERUM, OPEN SPINA BIFIDA
|
Facility
OP
|
$41.93
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
40609038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.77
|
| Rate for Payer: Aetna Government |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$16.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.93
|
| Rate for Payer: Group Health Inc Commercial |
$16.77
|
| Rate for Payer: Group Health Inc Medicare |
$16.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.77
|
| Rate for Payer: Healthfirst QHP |
$16.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.42
|
| Rate for Payer: Wellcare Medicare |
$15.09
|
|
|
AFP, SERUM, TUMOR MARKER
|
Facility
OP
|
$41.93
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
40608028
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.77
|
| Rate for Payer: Aetna Government |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$16.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.93
|
| Rate for Payer: Group Health Inc Commercial |
$16.77
|
| Rate for Payer: Group Health Inc Medicare |
$16.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.77
|
| Rate for Payer: Healthfirst QHP |
$16.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.42
|
| Rate for Payer: Wellcare Medicare |
$15.09
|
|
|
AFP, SERUM, TUMOR_MARKER
|
Facility
OP
|
$41.93
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
40609037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.77
|
| Rate for Payer: Aetna Government |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$16.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.93
|
| Rate for Payer: Group Health Inc Commercial |
$16.77
|
| Rate for Payer: Group Health Inc Medicare |
$16.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.77
|
| Rate for Payer: Healthfirst QHP |
$16.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.42
|
| Rate for Payer: Wellcare Medicare |
$15.09
|
|
|
AFP TETRA
|
Facility
OP
|
$41.93
|
|
|
Service Code
|
HCPCS 82105
|
| Hospital Charge Code |
40609039
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.77
|
| Rate for Payer: Aetna Government |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.77
|
| Rate for Payer: EmblemHealth Commercial |
$16.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.93
|
| Rate for Payer: Group Health Inc Commercial |
$16.77
|
| Rate for Payer: Group Health Inc Medicare |
$16.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.77
|
| Rate for Payer: Healthfirst QHP |
$16.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.42
|
| Rate for Payer: Wellcare Medicare |
$15.09
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
IP
|
$23,487.64
|
|
|
Service Code
|
MS-DRG 560
|
| Min. Negotiated Rate |
$9,707.76 |
| Max. Negotiated Rate |
$23,487.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,692.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,027.10
|
| Rate for Payer: Aetna Government |
$23,027.10
|
| Rate for Payer: Brighton Health Commercial |
$16,415.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,487.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,550.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,133.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,875.74
|
| Rate for Payer: EmblemHealth Commercial |
$9,707.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,027.10
|
| Rate for Payer: Group Health Inc Commercial |
$23,027.10
|
| Rate for Payer: Group Health Inc Medicare |
$23,027.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,027.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,707.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,027.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,027.10
|
| Rate for Payer: Wellcare Medicare |
$21,875.74
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
IP
|
$33,649.22
|
|
|
Service Code
|
MS-DRG 559
|
| Min. Negotiated Rate |
$15,340.08 |
| Max. Negotiated Rate |
$33,649.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27,285.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,989.43
|
| Rate for Payer: Aetna Government |
$32,989.43
|
| Rate for Payer: Brighton Health Commercial |
$26,832.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,649.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,956.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,371.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,339.96
|
| Rate for Payer: EmblemHealth Commercial |
$15,868.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,989.43
|
| Rate for Payer: Group Health Inc Commercial |
$32,989.43
|
| Rate for Payer: Group Health Inc Medicare |
$32,989.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,989.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,340.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,989.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,989.43
|
| Rate for Payer: Wellcare Medicare |
$31,339.96
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
IP
|
$18,510.11
|
|
|
Service Code
|
MS-DRG 561
|
| Min. Negotiated Rate |
$6,690.22 |
| Max. Negotiated Rate |
$18,510.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,504.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,147.17
|
| Rate for Payer: Aetna Government |
$18,147.17
|
| Rate for Payer: Brighton Health Commercial |
$11,312.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,510.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,473.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,118.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,239.81
|
| Rate for Payer: EmblemHealth Commercial |
$6,690.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,147.17
|
| Rate for Payer: Group Health Inc Commercial |
$18,147.17
|
| Rate for Payer: Group Health Inc Medicare |
$18,147.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,147.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,438.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,147.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,147.17
|
| Rate for Payer: Wellcare Medicare |
$17,239.81
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
IP
|
$22,648.87
|
|
|
Service Code
|
MS-DRG 949
|
| Min. Negotiated Rate |
$8,884.56 |
| Max. Negotiated Rate |
$22,648.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,277.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,204.77
|
| Rate for Payer: Aetna Government |
$22,204.77
|
| Rate for Payer: Brighton Health Commercial |
$15,023.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,648.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,526.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,288.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,094.53
|
| Rate for Payer: EmblemHealth Commercial |
$8,884.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,204.77
|
| Rate for Payer: Group Health Inc Commercial |
$22,204.77
|
| Rate for Payer: Group Health Inc Medicare |
$22,204.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,204.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,325.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,204.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,204.77
|
| Rate for Payer: Wellcare Medicare |
$21,094.53
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
IP
|
$16,507.22
|
|
|
Service Code
|
MS-DRG 950
|
| Min. Negotiated Rate |
$5,386.82 |
| Max. Negotiated Rate |
$16,507.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,262.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,183.55
|
| Rate for Payer: Aetna Government |
$16,183.55
|
| Rate for Payer: Brighton Health Commercial |
$9,108.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,507.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,027.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,100.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,374.37
|
| Rate for Payer: EmblemHealth Commercial |
$5,386.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,183.55
|
| Rate for Payer: Group Health Inc Commercial |
$16,183.55
|
| Rate for Payer: Group Health Inc Medicare |
$16,183.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,183.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,525.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,183.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,183.55
|
| Rate for Payer: Wellcare Medicare |
$15,374.37
|
|
|
AFTER CATARACT LASER SURGERY
|
Facility
OP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 66821
|
| Hospital Charge Code |
30302032
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$62,084.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$672.19
|
| Rate for Payer: Aetna Government |
$672.19
|
| Rate for Payer: Amida Care Medicaid |
$620.84
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$672.19
|
| 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 |
$672.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62,084.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$620.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$620.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$672.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.88
|
| 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 |
$620.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$672.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$620.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,396.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$571.36
|
| Rate for Payer: Healthfirst QHP |
$620.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$672.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$672.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$620.84
|
| Rate for Payer: SOMOS Essential |
$1,396.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$672.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$537.75
|
| Rate for Payer: Wellcare Medicare |
$638.58
|
|
|
AFTER CATARACT LASER SURGERY
|
Facility
OP
|
$1,535.38
|
|
|
Service Code
|
HCPCS 66821
|
| Hospital Charge Code |
40074219
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.75 |
| Max. Negotiated Rate |
$62,084.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$672.19
|
| Rate for Payer: Aetna Government |
$672.19
|
| Rate for Payer: Amida Care Medicaid |
$620.84
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Cash Price |
$672.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$672.19
|
| 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 |
$672.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62,084.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$620.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$620.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$672.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.88
|
| Rate for Payer: Group Health Inc Commercial |
$672.19
|
| Rate for Payer: Group Health Inc Medicare |
$672.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$620.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$672.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$620.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,396.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$571.36
|
| Rate for Payer: Healthfirst QHP |
$620.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$672.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$620.84
|
| Rate for Payer: SOMOS Essential |
$1,396.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$672.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$537.75
|
| Rate for Payer: Wellcare Medicare |
$638.58
|
|
|
AGENT HEMOSTATIC COLLAGEN 1GM
|
Facility
OP
|
$298.18
|
|
| Hospital Charge Code |
64902721
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.36 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$164.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$149.09
|
| Rate for Payer: Aetna Government |
$149.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$238.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$202.76
|
| Rate for Payer: Group Health Inc Commercial |
$149.09
|
| Rate for Payer: Group Health Inc Medicare |
$104.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.09
|
|
|
AGILE ESO FC
|
Facility
OP
|
$8,669.78
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,034.42 |
| Max. Negotiated Rate |
$9,103.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,768.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,334.89
|
| Rate for Payer: Aetna Government |
$4,334.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,334.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,985.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,103.27
|
| Rate for Payer: Group Health Inc Commercial |
$4,334.89
|
| Rate for Payer: Group Health Inc Medicare |
$3,034.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,334.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,334.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,635.36
|
|
|
AGILE ESO FC
|
Facility
IP
|
$8,669.78
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,334.89 |
| Max. Negotiated Rate |
$4,334.89 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,334.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,334.89
|
|
|
AHMED CAPSULAR TENSION SEGMENT
|
Facility
OP
|
$487.50
|
|
| Hospital Charge Code |
64904772
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$170.62 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$268.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$243.75
|
| Rate for Payer: Aetna Government |
$243.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$390.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$331.50
|
| Rate for Payer: Group Health Inc Commercial |
$243.75
|
| Rate for Payer: Group Health Inc Medicare |
$170.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.75
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
IP
|
$78,252.75
|
|
|
Service Code
|
MS-DRG 245
|
| Min. Negotiated Rate |
$32,627.43 |
| Max. Negotiated Rate |
$78,252.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66,815.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70,166.52
|
| Rate for Payer: Aetna Government |
$70,166.52
|
| Rate for Payer: Brighton Health Commercial |
$65,705.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71,569.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78,252.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64,577.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$66,658.19
|
| Rate for Payer: EmblemHealth Commercial |
$38,856.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$70,166.52
|
| Rate for Payer: Group Health Inc Commercial |
$70,166.52
|
| Rate for Payer: Group Health Inc Medicare |
$70,166.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70,166.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32,627.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70,166.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70,166.52
|
| Rate for Payer: Wellcare Medicare |
$66,658.19
|
|
|
AICD LEAD PROCEDURES
|
Facility
IP
|
$61,030.37
|
|
|
Service Code
|
MS-DRG 265
|
| Min. Negotiated Rate |
$26,196.51 |
| Max. Negotiated Rate |
$61,030.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52,110.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56,336.58
|
| Rate for Payer: Aetna Government |
$56,336.58
|
| Rate for Payer: Brighton Health Commercial |
$51,244.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57,463.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$61,030.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50,364.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$53,519.75
|
| Rate for Payer: EmblemHealth Commercial |
$30,304.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$56,336.58
|
| Rate for Payer: Group Health Inc Commercial |
$56,336.58
|
| Rate for Payer: Group Health Inc Medicare |
$56,336.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56,336.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,196.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56,336.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56,336.58
|
| Rate for Payer: Wellcare Medicare |
$53,519.75
|
|
|
AID SOCK & STOCKING
|
Facility
OP
|
$15.57
|
|
| Hospital Charge Code |
64903243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$12.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.78
|
| Rate for Payer: Aetna Government |
$7.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.59
|
| Rate for Payer: Group Health Inc Commercial |
$7.78
|
| Rate for Payer: Group Health Inc Medicare |
$5.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.78
|
|
|
AIR CAST
|
Facility
OP
|
$65.56
|
|
|
Service Code
|
HCPCS 99070
|
| Hospital Charge Code |
40202800
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$52.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.26
|
| Rate for Payer: Aetna Government |
$10.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.58
|
| Rate for Payer: Group Health Inc Commercial |
$32.78
|
| Rate for Payer: Group Health Inc Medicare |
$22.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.78
|
|
|
AIR MATTRESS
|
Facility
OP
|
$113.40
|
|
| Hospital Charge Code |
40200810
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.70
|
| Rate for Payer: Aetna Government |
$56.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.11
|
| Rate for Payer: Group Health Inc Commercial |
$56.70
|
| Rate for Payer: Group Health Inc Medicare |
$39.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.70
|
|
