|
EXPLORTRY LAP-APPENDECTOMY
|
Facility
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
40010855
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$699.08 |
| Max. Negotiated Rate |
$7,320.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$699.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$776.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
EXPLRTRY LAP-BOWEL RESECTION
|
Facility
OP
|
$4,205.72
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
40010875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,472.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,313.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,646.66
|
| Rate for Payer: Aetna Government |
$1,646.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,597.79
|
| Rate for Payer: Group Health Inc Commercial |
$2,102.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,472.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,102.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,102.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,775.32
|
|
|
EXPLRTRY LAP-BX ABDOMNL MASS
|
Facility
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
40010860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$395.29 |
| Max. Negotiated Rate |
$7,320.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$439.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
EXT CEPHALIC VERSION
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
30102502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$3,615.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Amida Care Medicaid |
$35.35
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,535.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.12
|
| 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 |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.35
|
| Rate for Payer: Healthfirst Essential Plan |
$35.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$35.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.35
|
| Rate for Payer: SOMOS Essential |
$35.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
EXT CEPHALIC VERSION
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
40052244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$3,615.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Amida Care Medicaid |
$35.35
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,535.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.12
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.35
|
| Rate for Payer: Healthfirst Essential Plan |
$35.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$35.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.35
|
| Rate for Payer: SOMOS Essential |
$35.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
EXTENDED BATHBRUSH
|
Facility
OP
|
$17.01
|
|
| Hospital Charge Code |
40201518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.50
|
| Rate for Payer: Aetna Government |
$8.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.57
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
|
|
EXTENDED LOCAL ANESTHESIA MARCAIN
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
HCPCS D9613
|
| Hospital Charge Code |
42300756
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.77
|
| Rate for Payer: Aetna Government |
$6.77
|
| 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 |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
EXTENSION PIECE - GMRS
|
Facility
IP
|
$10,211.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,105.62 |
| Max. Negotiated Rate |
$5,105.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,105.62
|
|
|
EXTENSION PIECE - GMRS
|
Facility
OP
|
$10,211.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$10,721.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,616.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,105.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,871.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,721.81
|
| Rate for Payer: Group Health Inc Commercial |
$5,105.62
|
| Rate for Payer: Group Health Inc Medicare |
$3,573.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,105.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,637.31
|
|
|
EXTENSION SET/2 INJECT SITES
|
Facility
OP
|
$5.09
|
|
| Hospital Charge Code |
64901298
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.54
|
| Rate for Payer: Aetna Government |
$2.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.46
|
| Rate for Payer: Group Health Inc Commercial |
$2.54
|
| Rate for Payer: Group Health Inc Medicare |
$1.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.54
|
|
|
EXTENSION STEM 14MM DIA LONG 1
|
Facility
OP
|
$4,602.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,832.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,531.38
|
| 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 |
$2,301.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,646.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,832.62
|
| Rate for Payer: Group Health Inc Commercial |
$2,301.25
|
| Rate for Payer: Group Health Inc Medicare |
$1,610.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,301.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,301.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,991.62
|
|
|
EXTENSION STEM 14MM DIA LONG 1
|
Facility
IP
|
$4,602.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.25 |
| Max. Negotiated Rate |
$2,301.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,301.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,301.25
|
|
|
EXTENSION STEM 18MM DIA LONG 1
|
Facility
IP
|
$4,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,240.00
|
|
|
EXTENSION STEM 18MM DIA LONG 1
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,464.00
|
| 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 |
$2,240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,576.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,704.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,240.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,568.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,240.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,912.00
|
|
|
EXTENSION STEM 20MM DIA LONG 1
|
Facility
OP
|
$4,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,464.00
|
| 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 |
$2,240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,576.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,704.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,240.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,568.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,240.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,912.00
|
|
|
EXTENSION STEM 20MM DIA LONG 1
|
Facility
IP
|
$4,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,240.00
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
IP
|
$52,359.61
|
|
|
Service Code
|
MS-DRG 933
|
| Min. Negotiated Rate |
$22,958.78 |
| Max. Negotiated Rate |
$52,359.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,706.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49,373.73
|
| Rate for Payer: Aetna Government |
$49,373.73
|
| Rate for Payer: Brighton Health Commercial |
$43,964.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50,361.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52,359.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43,209.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$46,905.04
|
| Rate for Payer: EmblemHealth Commercial |
$25,999.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$49,373.73
|
| Rate for Payer: Group Health Inc Commercial |
$49,373.73
|
| Rate for Payer: Group Health Inc Medicare |
$49,373.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49,373.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22,958.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49,373.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49,373.73
|
| Rate for Payer: Wellcare Medicare |
$46,905.04
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
IP
|
$455,188.39
|
|
|
Service Code
|
MS-DRG 927
|
| Min. Negotiated Rate |
$173,377.14 |
| Max. Negotiated Rate |
$455,188.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388,659.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$372,854.07
|
| Rate for Payer: Aetna Government |
$372,854.07
|
| Rate for Payer: Brighton Health Commercial |
$382,201.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380,311.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$455,188.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375,641.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$354,211.37
|
| Rate for Payer: EmblemHealth Commercial |
$226,026.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$372,854.07
|
| Rate for Payer: Group Health Inc Commercial |
$372,854.07
|
| Rate for Payer: Group Health Inc Medicare |
$372,854.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$372,854.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173,377.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$372,854.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$372,854.07
|
| Rate for Payer: Wellcare Medicare |
$354,211.37
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
IP
|
$42,930.73
|
|
|
Service Code
|
MS-DRG 982
|
| Min. Negotiated Rate |
$19,438.00 |
| Max. Negotiated Rate |
$42,930.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36,656.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41,802.15
|
| Rate for Payer: Aetna Government |
$41,802.15
|
| Rate for Payer: Brighton Health Commercial |
$36,047.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42,638.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42,930.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35,428.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$39,712.04
|
| Rate for Payer: EmblemHealth Commercial |
$21,317.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$41,802.15
|
| Rate for Payer: Group Health Inc Commercial |
$41,802.15
|
| Rate for Payer: Group Health Inc Medicare |
$41,802.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41,802.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,438.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41,802.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41,802.15
|
| Rate for Payer: Wellcare Medicare |
$39,712.04
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
IP
|
$81,861.97
|
|
|
Service Code
|
MS-DRG 981
|
| Min. Negotiated Rate |
$33,975.12 |
| Max. Negotiated Rate |
$81,861.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69,897.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73,064.78
|
| Rate for Payer: Aetna Government |
$73,064.78
|
| Rate for Payer: Brighton Health Commercial |
$68,735.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74,526.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81,861.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67,556.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$69,411.54
|
| Rate for Payer: EmblemHealth Commercial |
$40,648.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$73,064.78
|
| Rate for Payer: Group Health Inc Commercial |
$73,064.78
|
| Rate for Payer: Group Health Inc Medicare |
$73,064.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73,064.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33,975.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73,064.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73,064.78
|
| Rate for Payer: Wellcare Medicare |
$69,411.54
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$30,603.87
|
|
|
Service Code
|
MS-DRG 983
|
| Min. Negotiated Rate |
$13,951.76 |
| Max. Negotiated Rate |
$30,603.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,111.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,003.79
|
| Rate for Payer: Aetna Government |
$30,003.79
|
| Rate for Payer: Brighton Health Commercial |
$23,710.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,603.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,238.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,303.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,503.60
|
| Rate for Payer: EmblemHealth Commercial |
$14,021.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,003.79
|
| Rate for Payer: Group Health Inc Commercial |
$30,003.79
|
| Rate for Payer: Group Health Inc Medicare |
$30,003.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,003.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,951.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,003.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,003.79
|
| Rate for Payer: Wellcare Medicare |
$28,503.60
|
|
|
EXTERNAL BLEACHING - PER ARCH
|
Facility
OP
|
$709.00
|
|
|
Service Code
|
HCPCS D9972
|
| Hospital Charge Code |
42303378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$389.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.53
|
| Rate for Payer: Aetna Government |
$72.53
|
| 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 |
$354.50
|
| Rate for Payer: Group Health Inc Medicare |
$248.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.50
|
|
|
EXTERNAL BLEACHING - PER TOOTH
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
HCPCS D9973
|
| Hospital Charge Code |
42303379
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.06
|
| Rate for Payer: Aetna Government |
$12.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$42.50
|
| Rate for Payer: Group Health Inc Medicare |
$29.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.50
|
|
|
EXTERNAL FIXATION
|
Facility
OP
|
$17,690.84
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
40029802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$675.29 |
| Max. Negotiated Rate |
$8,845.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$675.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,845.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$750.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation
|
Facility
OP
|
$4,065.00
|
|
|
Service Code
|
CPT 66982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$786.10 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,694.88
|
| 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: Elderplan Medicare Advantage |
$2,694.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$786.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,290.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,398.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,694.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,398.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,694.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,694.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,694.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$873.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,694.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,155.90
|
| Rate for Payer: Wellcare Medicare |
$2,560.14
|
|
