|
C REP TRUNK, 1.1-2.5CM
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
30305077
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
C REP TRUNK, 1.1-2.5CM
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
30305077
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| 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 |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Humana Medicare |
$740.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
C REP TRUNK, 2.6 TO 7.5CM
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
30103263
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.40
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$726.29
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| 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 |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Humana Medicare |
$740.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
C REP TRUNK, 2.6 TO 7.5CM
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13101
|
| Hospital Charge Code |
30103263
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
CR FEMORAL 67.5MM RIGHT INTERLOCK
|
Facility
|
OP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,872.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,552.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,784.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,668.00
|
| Rate for Payer: EmblemHealth Commercial |
$2,320.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,872.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,320.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,016.00
|
|
|
CR FEMORAL 67.5MM RIGHT INTERLOCK
|
Facility
|
IP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,320.00 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
|
|
CR FEMORAL 70MM RIGHT INTERLOK
|
Facility
|
IP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,320.00 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
|
|
CR FEMORAL 70MM RIGHT INTERLOK
|
Facility
|
OP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,872.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,552.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,784.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,668.00
|
| Rate for Payer: EmblemHealth Commercial |
$2,320.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,872.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,320.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,016.00
|
|
|
CRHO REAR LIGATOR
|
Facility
|
OP
|
$3,250.00
|
|
| Hospital Charge Code |
64905060
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,137.50 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,787.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,625.00
|
| Rate for Payer: Aetna Government |
$1,625.00
|
| Rate for Payer: Brighton Health Commercial |
$2,437.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,210.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,625.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,625.00
|
|
|
CRILE-WOOD NH 6
|
Facility
|
OP
|
$210.38
|
|
| Hospital Charge Code |
64903605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.63 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.19
|
| Rate for Payer: Aetna Government |
$105.19
|
| Rate for Payer: Brighton Health Commercial |
$157.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.06
|
| Rate for Payer: Group Health Inc Commercial |
$105.19
|
| Rate for Payer: Group Health Inc Medicare |
$73.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.19
|
|
|
CRISIS INTERV/15 MIN
|
Facility
|
OP
|
$250.63
|
|
|
Service Code
|
HCPCS H2011
|
| Hospital Charge Code |
30400076
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$8,416.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.79
|
| Rate for Payer: Aetna Government |
$7.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$189.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$189.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$84.16
|
| Rate for Payer: Amida Care Medicaid |
$84.16
|
| Rate for Payer: Brighton Health Commercial |
$187.97
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$84.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8,416.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.37
|
| Rate for Payer: Group Health Inc Commercial |
$125.32
|
| Rate for Payer: Group Health Inc Medicare |
$87.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.16
|
| Rate for Payer: Healthfirst Essential Plan |
$189.36
|
| Rate for Payer: Healthfirst QHP |
$84.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.07
|
| Rate for Payer: Optum Medicaid |
$84.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.16
|
| Rate for Payer: SOMOS Essential |
$189.36
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$189.36
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$92.58
|
| Rate for Payer: United Healthcare Medicaid |
$84.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.16
|
|
|
CRISIS INTERV/15 MIN
|
Facility
|
OP
|
$250.63
|
|
|
Service Code
|
HCPCS H2011
|
| Hospital Charge Code |
30303118
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$8,416.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.79
|
| Rate for Payer: Aetna Government |
$7.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$189.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$189.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$84.16
|
| Rate for Payer: Amida Care Medicaid |
$84.16
|
| Rate for Payer: Brighton Health Commercial |
$187.97
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$84.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8,416.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.37
|
| Rate for Payer: Group Health Inc Commercial |
$125.32
|
| Rate for Payer: Group Health Inc Medicare |
$87.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.16
|
| Rate for Payer: Healthfirst Essential Plan |
$189.36
|
| Rate for Payer: Healthfirst QHP |
$84.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.07
|
| Rate for Payer: Optum Medicaid |
$84.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.16
|
| Rate for Payer: SOMOS Essential |
$189.36
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$189.36
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$92.58
|
| Rate for Payer: United Healthcare Medicaid |
$84.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.16
|
|
|
CRISIS INTERVENTION/DIEM
|
Facility
|
OP
|
$250.63
|
|
|
Service Code
|
HCPCS S9485
|
| Hospital Charge Code |
30400078
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$121,873.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.29
|
| Rate for Payer: Aetna Government |
$69.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,742.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,742.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,218.73
|
| Rate for Payer: Amida Care Medicaid |
$1,218.73
|
| Rate for Payer: Brighton Health Commercial |
$187.97
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$1,229.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121,873.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,218.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,218.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,279.67
|
| Rate for Payer: Group Health Inc Commercial |
$125.32
|
| Rate for Payer: Group Health Inc Medicare |
$87.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,218.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,218.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,742.14
|
| Rate for Payer: Healthfirst QHP |
$1,218.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,229.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,767.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,767.16
|
| Rate for Payer: Optum Medicaid |
$1,229.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,218.73
|
| Rate for Payer: SOMOS Essential |
$2,742.14
|
| Rate for Payer: United Healthcare Commercial |
$125.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$2,742.14
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,340.60
|
| Rate for Payer: United Healthcare Medicaid |
$1,218.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,218.73
|
|
|
CRISIS INTERVENTION/DIEM
|
Facility
|
OP
|
$250.63
|
|
|
Service Code
|
HCPCS S9485
|
| Hospital Charge Code |
30303127
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$121,873.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.29
|
| Rate for Payer: Aetna Government |
$69.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,742.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,742.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,218.73
|
| Rate for Payer: Amida Care Medicaid |
$1,218.73
|
| Rate for Payer: Brighton Health Commercial |
$187.97
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$1,229.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121,873.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,218.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,218.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,279.67
|
| Rate for Payer: Group Health Inc Commercial |
$125.32
|
| Rate for Payer: Group Health Inc Medicare |
$87.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,218.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,218.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,742.14
|
| Rate for Payer: Healthfirst QHP |
$1,218.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,229.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,767.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,767.16
|
| Rate for Payer: Optum Medicaid |
$1,229.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,218.73
|
| Rate for Payer: SOMOS Essential |
$2,742.14
|
| Rate for Payer: United Healthcare Commercial |
$125.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$2,742.14
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,340.60
|
| Rate for Payer: United Healthcare Medicaid |
$1,218.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,218.73
|
|
|
CRISIS INTERVENTION/HR
|
Facility
|
OP
|
$250.63
|
|
|
Service Code
|
HCPCS S9484
|
| Hospital Charge Code |
30400077
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$24.79 |
| Max. Negotiated Rate |
$50,780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.79
|
| Rate for Payer: Aetna Government |
$24.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,142.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,142.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$507.80
|
| Rate for Payer: Amida Care Medicaid |
$507.80
|
| Rate for Payer: Brighton Health Commercial |
$187.97
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$512.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50,780.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$507.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$507.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$533.19
|
| Rate for Payer: Group Health Inc Commercial |
$125.32
|
| Rate for Payer: Group Health Inc Medicare |
$87.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,142.55
|
| Rate for Payer: Healthfirst QHP |
$507.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$512.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,152.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,152.99
|
| Rate for Payer: Optum Medicaid |
$512.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$507.80
|
| Rate for Payer: SOMOS Essential |
$1,142.55
|
| Rate for Payer: United Healthcare Commercial |
$125.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,142.55
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$558.58
|
| Rate for Payer: United Healthcare Medicaid |
$507.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$507.80
|
|
|
CRISIS INTERVENTION/HR
|
Facility
|
OP
|
$250.63
|
|
|
Service Code
|
HCPCS S9484
|
| Hospital Charge Code |
30303126
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$24.79 |
| Max. Negotiated Rate |
$50,780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.79
|
| Rate for Payer: Aetna Government |
$24.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,142.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,142.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$507.80
|
| Rate for Payer: Amida Care Medicaid |
$507.80
|
| Rate for Payer: Brighton Health Commercial |
$187.97
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$512.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50,780.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$507.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$507.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$533.19
|
| Rate for Payer: Group Health Inc Commercial |
$125.32
|
| Rate for Payer: Group Health Inc Medicare |
$87.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,142.55
|
| Rate for Payer: Healthfirst QHP |
$507.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$512.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,152.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,152.99
|
| Rate for Payer: Optum Medicaid |
$512.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$507.80
|
| Rate for Payer: SOMOS Essential |
$1,142.55
|
| Rate for Payer: United Healthcare Commercial |
$125.32
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,142.55
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$558.58
|
| Rate for Payer: United Healthcare Medicaid |
$507.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$507.80
|
|
|
CRITI AID
|
Facility
|
OP
|
$24.45
|
|
| Hospital Charge Code |
40204855
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$19.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.22
|
| Rate for Payer: Aetna Government |
$12.22
|
| Rate for Payer: Brighton Health Commercial |
$18.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.63
|
| Rate for Payer: Group Health Inc Commercial |
$12.22
|
| Rate for Payer: Group Health Inc Medicare |
$8.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.22
|
|
|
CRITICAL CARE - ADDITIONAL 30 MIN
|
Facility
|
OP
|
$499.36
|
|
|
Service Code
|
HCPCS 99292
|
| Hospital Charge Code |
30100009
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.85
|
| Rate for Payer: Aetna Government |
$83.85
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$249.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$249.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
CRITICAL CARE EVAL AND MGMT
|
Facility
|
OP
|
$2,019.15
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
30101432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,046.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,026.18
|
| Rate for Payer: Aetna Government |
$1,026.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$718.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$718.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$718.33
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,026.18
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,026.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,026.18
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$872.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$913.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,026.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$913.30
|
| 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 |
$1,009.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,026.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,026.18
|
| Rate for Payer: Humana Medicare |
$1,046.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,026.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,026.18
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,026.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,026.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$820.94
|
| Rate for Payer: Wellcare Medicare |
$974.87
|
|
|
CRITICAL CARE EVAL AND MGMT
|
Facility
|
IP
|
$2,019.15
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
30101432
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,026.18
|
|
|
CRITICAL CARE EVAL & MGMT
|
Facility
|
IP
|
$2,019.15
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
30100008
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,026.18
|
|
|
CRITICAL CARE EVAL & MGMT
|
Facility
|
OP
|
$2,019.15
|
|
|
Service Code
|
HCPCS 99291
|
| Hospital Charge Code |
30100008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,046.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,026.18
|
| Rate for Payer: Aetna Government |
$1,026.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$718.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$718.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$718.33
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,026.18
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,026.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,026.18
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$872.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$913.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,026.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$913.30
|
| 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 |
$1,009.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,026.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,026.18
|
| Rate for Payer: Humana Medicare |
$1,046.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,026.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,026.18
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,026.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,026.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$820.94
|
| Rate for Payer: Wellcare Medicare |
$974.87
|
|
|
CRITICAL SCREW 4.5X36MM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$19.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.40
|
| Rate for Payer: EmblemHealth Commercial |
$16.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.60
|
| Rate for Payer: Group Health Inc Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.80
|
|
|
CRITICAL SCREW 4.5X36MM
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200533
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
|
|
Critikit
|
Facility
|
OP
|
$97.45
|
|
| Hospital Charge Code |
40200935
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$77.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.72
|
| Rate for Payer: Aetna Government |
$48.72
|
| Rate for Payer: Brighton Health Commercial |
$73.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.27
|
| Rate for Payer: Group Health Inc Commercial |
$48.72
|
| Rate for Payer: Group Health Inc Medicare |
$34.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.72
|
|
