|
17-HYDROXYCORTICOSTEROIDS
|
Facility
OP
|
$44.75
|
|
|
Service Code
|
HCPCS 83491
|
| Hospital Charge Code |
40609884
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$27.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.90
|
| Rate for Payer: Aetna Government |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.90
|
| Rate for Payer: EmblemHealth Commercial |
$17.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.93
|
| Rate for Payer: Group Health Inc Commercial |
$17.90
|
| Rate for Payer: Group Health Inc Medicare |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.90
|
| Rate for Payer: Healthfirst QHP |
$17.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Wellcare Medicare |
$16.11
|
|
|
17-HYDROXYPREGNENOLONE, MS
|
Facility
OP
|
$57.03
|
|
|
Service Code
|
HCPCS 84143
|
| Hospital Charge Code |
40609109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.81
|
| Rate for Payer: Aetna Government |
$22.81
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.81
|
| Rate for Payer: EmblemHealth Commercial |
$22.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.30
|
| Rate for Payer: Group Health Inc Commercial |
$22.81
|
| Rate for Payer: Group Health Inc Medicare |
$22.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.81
|
| Rate for Payer: Healthfirst QHP |
$22.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.25
|
| Rate for Payer: Wellcare Medicare |
$20.53
|
|
|
1.7 MIDFACE FIXATION MODULE
|
Facility
IP
|
$267.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$133.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.80
|
|
|
1.7 MIDFACE FIXATION MODULE
|
Facility
OP
|
$267.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209413
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.66 |
| Max. Negotiated Rate |
$280.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$153.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.98
|
| Rate for Payer: Group Health Inc Commercial |
$133.80
|
| Rate for Payer: Group Health Inc Medicare |
$93.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.94
|
|
|
1.7MM DYNAMIC MESH 90X90X.3MM
|
Facility
OP
|
$3,190.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$3,349.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,754.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,595.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,834.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,349.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,595.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,116.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,595.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,073.50
|
|
|
1.7MM DYNAMIC MESH 90X90X.3MM
|
Facility
IP
|
$3,190.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,595.00 |
| Max. Negotiated Rate |
$1,595.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,595.00
|
|
|
1.7MM DYNAMIC MESH 90X90X.6MM
|
Facility
OP
|
$3,190.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$3,349.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,754.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,595.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,834.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,349.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,595.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,116.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,595.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,073.50
|
|
|
1.7MM DYNAMIC MESH 90X90X.6MM
|
Facility
IP
|
$3,190.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,595.00 |
| Max. Negotiated Rate |
$1,595.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,595.00
|
|
|
17MM METATARSAL IMPLANT
|
Facility
OP
|
$3,900.00
|
|
| Hospital Charge Code |
40200163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,145.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,950.00
|
| Rate for Payer: Aetna Government |
$1,950.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,120.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,652.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,950.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,365.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,950.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,950.00
|
|
|
17-OH PROGESTERONE LCMS
|
Facility
OP
|
$68.75
|
|
|
Service Code
|
HCPCS 83498
|
| Hospital Charge Code |
40609086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$43.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.17
|
| Rate for Payer: Aetna Government |
$27.17
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.17
|
| Rate for Payer: EmblemHealth Commercial |
$27.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.18
|
| Rate for Payer: Group Health Inc Commercial |
$27.17
|
| Rate for Payer: Group Health Inc Medicare |
$27.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.17
|
| Rate for Payer: Healthfirst QHP |
$27.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.74
|
| Rate for Payer: Wellcare Medicare |
$24.45
|
|
|
18H STRT PLATE UP MALLEABLE
|
Facility
OP
|
$822.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$452.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$411.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$472.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$863.10
|
| Rate for Payer: Group Health Inc Commercial |
$411.00
|
| Rate for Payer: Group Health Inc Medicare |
$287.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$534.30
|
|
|
18H STRT PLATE UP MALLEABLE
|
Facility
IP
|
$822.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.00 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.00
|
|
|
18H STRT PLT UP MALLEABLE
|
Facility
IP
|
$822.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.00 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.00
|
|
|
18H STRT PLT UP MALLEABLE
|
Facility
OP
|
$822.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$452.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$411.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$472.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$863.10
|
| Rate for Payer: Group Health Inc Commercial |
$411.00
|
| Rate for Payer: Group Health Inc Medicare |
$287.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$534.30
|
|
|
18MM LOCKING SCREW 212.105
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
|
|
18MM LOCKING SCREW 212.105
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.50
|
| Rate for Payer: Group Health Inc Commercial |
$135.00
|
| Rate for Payer: Group Health Inc Medicare |
$94.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.50
|
|
|
1.9 X3MM EMERGENCY SCREW
|
Facility
IP
|
$117.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$58.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.62
|
|
|
1.9 X3MM EMERGENCY SCREW
|
Facility
OP
|
$117.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.03 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.10
|
| Rate for Payer: Group Health Inc Commercial |
$58.62
|
| Rate for Payer: Group Health Inc Medicare |
$41.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.21
|
|
|
1ST PSYC COLLAB CARE MGMT
|
Facility
OP
|
$237.88
|
|
|
Service Code
|
HCPCS 99492
|
| Hospital Charge Code |
30300186
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$82.46 |
| Max. Negotiated Rate |
$190.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.08
|
| Rate for Payer: Aetna Government |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$103.08
|
| Rate for Payer: EmblemHealth Commercial |
$103.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.74
|
| Rate for Payer: Group Health Inc Commercial |
$103.08
|
| Rate for Payer: Group Health Inc Medicare |
$103.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.62
|
| Rate for Payer: Healthfirst QHP |
$103.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.46
|
| Rate for Payer: Wellcare Medicare |
$97.93
|
|
|
1ST/SBSQ PSYC COLLAB CARE
|
Facility
OP
|
$112.50
|
|
|
Service Code
|
HCPCS 99494
|
| Hospital Charge Code |
30300188
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.00
|
| Rate for Payer: Aetna Government |
$32.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.46
|
| Rate for Payer: Group Health Inc Commercial |
$56.25
|
| Rate for Payer: Group Health Inc Medicare |
$39.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.18
|
|
|
1 UNIT BLOOD (1 PINT 500CC)
|
Facility
OP
|
$385.25
|
|
|
Service Code
|
HCPCS P9010
|
| Hospital Charge Code |
40701001
|
|
Hospital Revenue Code
|
382
|
| Min. Negotiated Rate |
$192.62 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$211.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.51
|
| Rate for Payer: Aetna Government |
$246.51
|
| Rate for Payer: Brighton Health Commercial |
$246.51
|
| Rate for Payer: Cash Price |
$246.51
|
| Rate for Payer: Cash Price |
$246.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$308.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$261.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.51
|
| Rate for Payer: EmblemHealth Commercial |
$246.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.39
|
| Rate for Payer: Group Health Inc Commercial |
$246.51
|
| Rate for Payer: Group Health Inc Medicare |
$246.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.53
|
| Rate for Payer: Healthfirst QHP |
$246.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.21
|
| Rate for Payer: Wellcare Medicare |
$221.86
|
|
|
1 UNIT FROZEN PLASMA HUMAN 250CC
|
Facility
OP
|
$459.10
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
40701011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$252.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$252.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
20% DEXTROSE IN WATER -500CC
|
Facility
OP
|
$12.76
|
|
| Hospital Charge Code |
40501251
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.38
|
| Rate for Payer: Aetna Government |
$6.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.68
|
| Rate for Payer: Group Health Inc Commercial |
$6.38
|
| Rate for Payer: Group Health Inc Medicare |
$4.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.38
|
|
|
20 HL STRT PLT MDFC MALLEABLE
|
Facility
OP
|
$864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$475.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$496.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$907.20
|
| Rate for Payer: Group Health Inc Commercial |
$432.00
|
| Rate for Payer: Group Health Inc Medicare |
$302.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$561.60
|
|
|
20 HL STRT PLT MDFC MALLEABLE
|
Facility
IP
|
$864.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.00
|
|
