|
DECALCIFICATION PROCEDURE
|
Facility
|
OP
|
$32.60
|
|
|
Service Code
|
HCPCS 88311
|
| Hospital Charge Code |
40635461
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$24.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.59
|
| Rate for Payer: Aetna Government |
$13.59
|
| Rate for Payer: Brighton Health Commercial |
$24.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.49
|
| Rate for Payer: Group Health Inc Commercial |
$16.30
|
| Rate for Payer: Group Health Inc Medicare |
$11.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.30
|
|
|
DECANNULATION OF TRACHEOSTOMY
|
Facility
|
IP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
40302450
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$3,723.23
|
|
|
DECANNULATION OF TRACHEOSTOMY
|
Facility
|
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 69424
|
| Hospital Charge Code |
40302450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| 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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,723.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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
|
|
|
DECANTER BAG 9IN
|
Facility
|
OP
|
$3.40
|
|
| Hospital Charge Code |
64903127
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Brighton Health Commercial |
$2.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
|
|
DECANTER BAG II STERILE
|
Facility
|
OP
|
$2.68
|
|
| Hospital Charge Code |
40202184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.34
|
| Rate for Payer: Aetna Government |
$1.34
|
| Rate for Payer: Brighton Health Commercial |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.82
|
| Rate for Payer: Group Health Inc Commercial |
$1.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.34
|
|
|
DECITABINE 50 MG IV SOLR [76364]
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
55150037601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.43
|
| Rate for Payer: Aetna Government |
$3.43
|
| Rate for Payer: Brighton Health Commercial |
$270.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.75
|
| Rate for Payer: EmblemHealth Commercial |
$225.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$472.50
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
|
DECITABINE 50 MG IV SOLR [76364]
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
00143938501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.43
|
| Rate for Payer: Aetna Government |
$3.43
|
| Rate for Payer: Brighton Health Commercial |
$72.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$60.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.00
|
| Rate for Payer: EmblemHealth Commercial |
$60.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.00
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.00
|
|
|
DECITABINE 50 MG IV SOLR [76364]
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
00143938501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
|
|
DECITABINE 50 MG IV SOLR [76364]
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
55150037601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
|
|
DECITABINE 50 MG SUBCUTANEOUS SOLUTION [4082748]
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
00143938501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.43
|
| Rate for Payer: Aetna Government |
$3.43
|
| Rate for Payer: Brighton Health Commercial |
$90.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.60
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.00
|
|
|
DECLOTTING A/V GRAFT
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36860
|
| Hospital Charge Code |
40032010
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
DECLOTTING A/V GRAFT
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36860
|
| Hospital Charge Code |
40032010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$954.82 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,852.05
|
| Rate for Payer: Aetna Government |
$1,852.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,296.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,296.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,296.44
|
| Rate for Payer: Brighton Health Commercial |
$1,432.24
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,852.05
|
| 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 |
$1,852.05
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,574.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,648.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,852.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,648.32
|
| Rate for Payer: Group Health Inc Commercial |
$1,852.05
|
| Rate for Payer: Group Health Inc Medicare |
$1,852.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,574.24
|
| Rate for Payer: Healthfirst QHP |
$1,852.05
|
| Rate for Payer: Humana Medicare |
$1,889.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,852.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,481.64
|
| Rate for Payer: Wellcare Medicare |
$1,759.45
|
|
|
DECLOTTING VASCULAR DEVICE
|
Facility
|
IP
|
$937.70
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
30305690
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$391.64
|
|
|
DECLOTTING VASCULAR DEVICE
|
Facility
|
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
30305690
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.15 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$274.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$274.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$274.15
|
| Rate for Payer: Brighton Health Commercial |
$703.28
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| 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 |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$391.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$332.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$348.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$348.56
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Humana Medicare |
$399.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
DECLOT VASCULAR DEVICE
|
Facility
|
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
40034087
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$274.15 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$274.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$274.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$274.15
|
| Rate for Payer: Brighton Health Commercial |
$703.28
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| 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 |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$332.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$348.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$348.56
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Humana Medicare |
$399.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
DECLOT VASCULAR DEVICE
|
Facility
|
IP
|
$937.70
|
|
|
Service Code
|
HCPCS 36593
|
| Hospital Charge Code |
40034087
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$391.64
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Facility
|
IP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 25025
|
| Hospital Charge Code |
30303051
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,858.61
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Facility
|
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 25025
|
| Hospital Charge Code |
30303051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,301.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,301.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,301.03
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| 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 |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Humana Medicare |
$1,895.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
DECOMPRESSION OF TIBIA NERVE
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 28035
|
| Hospital Charge Code |
40029403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,905.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$3,905.61
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
| Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
DECOMPRESSION OF TIBIA NERVE
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 28035
|
| Hospital Charge Code |
40029403
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
DECORTICATION - LUNG
|
Facility
|
OP
|
$3,364.10
|
|
|
Service Code
|
HCPCS 32220
|
| Hospital Charge Code |
40042105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,177.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,850.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,729.07
|
| Rate for Payer: Aetna Government |
$1,729.07
|
| Rate for Payer: Brighton Health Commercial |
$2,523.08
|
| 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: Group Health Inc Commercial |
$1,682.05
|
| Rate for Payer: Group Health Inc Medicare |
$1,177.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,682.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,682.05
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
DEEP SEDATION/GENERAL ANESTHESIA
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS D9222
|
| Hospital Charge Code |
42300752
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$29,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.36
|
| Rate for Payer: Aetna Government |
$52.36
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$668.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$668.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$297.22
|
| Rate for Payer: Amida Care Medicaid |
$297.22
|
| Rate for Payer: Brighton Health Commercial |
$142.50
|
| 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: Fidelis CHP/HARP/Medicaid |
$29,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$297.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$312.08
|
| Rate for Payer: Group Health Inc Commercial |
$95.00
|
| Rate for Payer: Group Health Inc Medicare |
$66.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.22
|
| Rate for Payer: Healthfirst Essential Plan |
$668.74
|
| Rate for Payer: Healthfirst QHP |
$297.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.22
|
| Rate for Payer: SOMOS Essential |
$668.74
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$668.74
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$326.94
|
| Rate for Payer: United Healthcare Medicaid |
$297.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$297.22
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC
|
Facility
|
IP
|
$30,930.08
|
|
|
Service Code
|
MSDRG 294
|
| Min. Negotiated Rate |
$9,378.48 |
| Max. Negotiated Rate |
$30,930.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,126.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,494.60
|
| Rate for Payer: Aetna Government |
$22,494.60
|
| Rate for Payer: Brighton Health Commercial |
$15,858.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,944.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,887.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,586.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,369.87
|
| Rate for Payer: EmblemHealth Commercial |
$9,378.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,494.60
|
| Rate for Payer: Group Health Inc Commercial |
$22,494.60
|
| Rate for Payer: Group Health Inc Medicare |
$22,494.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,494.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,459.99
|
| Rate for Payer: Humana Medicare |
$30,930.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,494.60
|
| Rate for Payer: United Healthcare Commercial |
$21,750.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,494.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,494.60
|
| Rate for Payer: Wellcare Medicare |
$21,369.87
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$25,274.60
|
|
|
Service Code
|
MSDRG 295
|
| Min. Negotiated Rate |
$5,415.11 |
| Max. Negotiated Rate |
$25,274.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,311.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,381.53
|
| Rate for Payer: Aetna Government |
$18,381.53
|
| Rate for Payer: Brighton Health Commercial |
$9,156.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,749.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,765.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,359.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,462.45
|
| Rate for Payer: EmblemHealth Commercial |
$5,415.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,381.53
|
| Rate for Payer: Group Health Inc Commercial |
$18,381.53
|
| Rate for Payer: Group Health Inc Medicare |
$18,381.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,381.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,547.41
|
| Rate for Payer: Humana Medicare |
$25,274.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,381.53
|
| Rate for Payer: United Healthcare Commercial |
$15,851.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,381.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,381.53
|
| Rate for Payer: Wellcare Medicare |
$17,462.45
|
|
|
DEFAZOLIN 1G/D5W 50ML-500MG
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
41658856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
|
