|
ADAPT PASTE 0.5OZ (14G) TUBE
|
Facility
|
OP
|
$29.66
|
|
|
Service Code
|
HCPCS A4406
|
| Hospital Charge Code |
40005171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Brighton Health Commercial |
$22.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.17
|
| Rate for Payer: Group Health Inc Commercial |
$14.83
|
| Rate for Payer: Group Health Inc Medicare |
$10.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.83
|
|
|
ADAPT POWDER 1OZ(28.3G)PUFF BOTTL
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
HCPCS A4371
|
| Hospital Charge Code |
40005172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.22
|
| Rate for Payer: Aetna Government |
$2.22
|
| Rate for Payer: Brighton Health Commercial |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.24
|
| Rate for Payer: Group Health Inc Commercial |
$1.65
|
| Rate for Payer: Group Health Inc Medicare |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.65
|
|
|
ADD'1 SEQUEN INFUSION UP TO 1 HR
|
Facility
|
IP
|
$183.15
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
40509867
|
|
Hospital Revenue Code
|
269
|
| Rate for Payer: Cash Price |
$81.46
|
|
|
ADD'1 SEQUEN INFUSION UP TO 1 HR
|
Facility
|
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
40509867
|
|
Hospital Revenue Code
|
269
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$57.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$57.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57.02
|
| Rate for Payer: Brighton Health Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.50
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
ADD A LINE SET
|
Facility
|
OP
|
$3.90
|
|
| Hospital Charge Code |
40509801
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.95
|
| Rate for Payer: Aetna Government |
$1.95
|
| Rate for Payer: Brighton Health Commercial |
$2.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.65
|
| Rate for Payer: Group Health Inc Commercial |
$1.95
|
| Rate for Payer: Group Health Inc Medicare |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
ADD CLASP TO EXISTING PARTIAL DEN
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS D5660
|
| Hospital Charge Code |
42301090
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.97
|
| Rate for Payer: Aetna Government |
$65.97
|
| Rate for Payer: Brighton Health Commercial |
$191.25
|
| 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 |
$127.50
|
| Rate for Payer: Group Health Inc Medicare |
$89.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.50
|
|
|
ADDED SKIN LESIONS INJECTION
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
42201730
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
ADDED SKIN LESIONS INJECTION
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
42201730
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.06 |
| 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: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| 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: 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 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 Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| 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: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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
|
|
|
ADDERALL XR 10MG
|
Facility
|
OP
|
$0.02
|
|
| Hospital Charge Code |
41658427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ADDERALL XR 10MG
|
Facility
|
OP
|
$0.02
|
|
| Hospital Charge Code |
41648427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ADDERALL XR 5MG
|
Facility
|
OP
|
$0.02
|
|
| Hospital Charge Code |
41648426
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ADDERALL XR 5MG
|
Facility
|
OP
|
$0.02
|
|
| Hospital Charge Code |
41658426
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ADD. FROZ SECT ON SAME SPECIM
|
Facility
|
OP
|
$81.51
|
|
|
Service Code
|
HCPCS 88332
|
| Hospital Charge Code |
40635440
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.49
|
| Rate for Payer: Aetna Government |
$31.49
|
| Rate for Payer: Brighton Health Commercial |
$61.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$40.76
|
| Rate for Payer: Group Health Inc Medicare |
$28.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.76
|
|
|
ADD'L SUBCUTANEOUS INF
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96370
|
| Hospital Charge Code |
40509899
|
|
Hospital Revenue Code
|
269
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$30,767.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$692.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$692.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.67
|
| Rate for Payer: Amida Care Medicaid |
$307.67
|
| Rate for Payer: Brighton Health Commercial |
$86.57
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: EmblemHealth Commercial |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,767.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$54.93
|
| Rate for Payer: Group Health Inc Medicare |
$54.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.67
|
| Rate for Payer: Healthfirst Essential Plan |
$692.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$307.67
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.67
|
| Rate for Payer: SOMOS Essential |
$692.26
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$692.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$338.44
|
| Rate for Payer: United Healthcare Medicaid |
$307.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
ADD'L SUBCUTANEOUS INF
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 96370
|
| Hospital Charge Code |
40509899
|
|
Hospital Revenue Code
|
269
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
ADD SEQUEN INF UP TO 1 HOUR
|
Facility
|
IP
|
$183.15
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
30106646
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$81.46
|
|
|
ADD SEQUEN INF UP TO 1 HOUR
|
Facility
|
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
30106646
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$57.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$57.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57.02
|
| Rate for Payer: Brighton Health Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.50
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
ADD SEQUEN INFUSION UP TO 1 HR
|
Facility
|
IP
|
$183.15
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
30306651
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$81.46
|
|
|
ADD SEQUEN INFUSION UP TO 1 HR
|
Facility
|
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
30306651
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$57.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$57.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$57.02
|
| Rate for Payer: Brighton Health Commercial |
$137.36
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.50
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
ADD TOOTH TO EXISTING PARTIAL DEN
|
Facility
|
OP
|
$162.50
|
|
|
Service Code
|
HCPCS D5650
|
| Hospital Charge Code |
42301085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.05
|
| Rate for Payer: Aetna Government |
$55.05
|
| Rate for Payer: Brighton Health Commercial |
$121.88
|
| 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 |
$81.25
|
| Rate for Payer: Group Health Inc Medicare |
$56.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.25
|
|
|
ADD WALKER TO CAST
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
HCPCS 29440
|
| Hospital Charge Code |
30301172
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
ADD WALKER TO CAST
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29440
|
| Hospital Charge Code |
30301172
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.55
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| 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 |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Humana Medicare |
$185.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
Adenoidectomy, primary; age 12 or over
|
Facility
|
OP
|
$3,797.69
|
|
|
Service Code
|
CPT 42831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,797.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,606.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,606.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,606.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Humana Medicare |
$3,797.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
ADENOSINE
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41655637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Brighton Health Commercial |
$0.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.59
|
| Rate for Payer: SOMOS Essential |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ADENOSINE
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41645637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
