|
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation
|
Facility
OP
|
$4,065.00
|
|
|
Service Code
|
CPT 66984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.45 |
| 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 |
$574.45
|
| 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 |
$638.28
|
| 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
|
|
|
EXTRACRANIAL PROCEDURES WITH CC
|
Facility
IP
|
$30,104.55
|
|
|
Service Code
|
MS-DRG 038
|
| Min. Negotiated Rate |
$13,719.10 |
| Max. Negotiated Rate |
$30,104.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,590.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,514.26
|
| Rate for Payer: Aetna Government |
$29,514.26
|
| Rate for Payer: Brighton Health Commercial |
$23,198.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,104.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,628.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,800.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,038.55
|
| Rate for Payer: EmblemHealth Commercial |
$13,719.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,514.26
|
| Rate for Payer: Group Health Inc Commercial |
$29,514.26
|
| Rate for Payer: Group Health Inc Medicare |
$29,514.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,514.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,724.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,514.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,514.26
|
| Rate for Payer: Wellcare Medicare |
$28,038.55
|
|
|
EXTRACRANIAL PROCEDURES WITH MCC
|
Facility
IP
|
$58,293.24
|
|
|
Service Code
|
MS-DRG 037
|
| Min. Negotiated Rate |
$25,174.44 |
| Max. Negotiated Rate |
$58,293.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49,773.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54,138.58
|
| Rate for Payer: Aetna Government |
$54,138.58
|
| Rate for Payer: Brighton Health Commercial |
$48,946.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55,221.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58,293.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48,106.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$51,431.65
|
| Rate for Payer: EmblemHealth Commercial |
$28,945.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$54,138.58
|
| Rate for Payer: Group Health Inc Commercial |
$54,138.58
|
| Rate for Payer: Group Health Inc Medicare |
$54,138.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54,138.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25,174.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54,138.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54,138.58
|
| Rate for Payer: Wellcare Medicare |
$51,431.65
|
|
|
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$23,613.53
|
|
|
Service Code
|
MS-DRG 039
|
| Min. Negotiated Rate |
$9,784.08 |
| Max. Negotiated Rate |
$23,613.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,824.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,150.52
|
| Rate for Payer: Aetna Government |
$23,150.52
|
| Rate for Payer: Brighton Health Commercial |
$16,544.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,613.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,703.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,260.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,992.99
|
| Rate for Payer: EmblemHealth Commercial |
$9,784.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,150.52
|
| Rate for Payer: Group Health Inc Commercial |
$23,150.52
|
| Rate for Payer: Group Health Inc Medicare |
$23,150.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,150.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,764.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,150.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,150.52
|
| Rate for Payer: Wellcare Medicare |
$21,992.99
|
|
|
EXTRACT ERUPTED TOOTH/EXPOSE ROOT
|
Facility
OP
|
$2,953.25
|
|
|
Service Code
|
HCPCS D7140
|
| Hospital Charge Code |
30106627
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,476.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,018.19
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| 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 |
$1,476.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
EXTRACTION 1 CORONAL REMNANTS
|
Facility
OP
|
$87.50
|
|
|
Service Code
|
HCPCS D7111
|
| Hospital Charge Code |
42303434
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
EXTRACTOR CORTEX .60MMX16MM
|
Facility
OP
|
$18.18
|
|
| Hospital Charge Code |
64904243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$14.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.09
|
| Rate for Payer: Aetna Government |
$9.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.36
|
| Rate for Payer: Group Health Inc Commercial |
$9.09
|
| Rate for Payer: Group Health Inc Medicare |
$6.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.09
|
|
|
EXTRACTOR PRO BALLOON RX 12-15MM
|
Facility
OP
|
$550.20
|
|
| Hospital Charge Code |
64904280
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.57 |
| Max. Negotiated Rate |
$440.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.10
|
| Rate for Payer: Aetna Government |
$275.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.14
|
| Rate for Payer: Group Health Inc Commercial |
$275.10
|
| Rate for Payer: Group Health Inc Medicare |
$192.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.10
|
|
|
EXTRACTOR PRO BALLOON RX 15-18MM
|
Facility
OP
|
$550.20
|
|
| Hospital Charge Code |
64904282
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.57 |
| Max. Negotiated Rate |
$440.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.10
|
| Rate for Payer: Aetna Government |
$275.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.14
|
| Rate for Payer: Group Health Inc Commercial |
$275.10
|
| Rate for Payer: Group Health Inc Medicare |
$192.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.10
|
|
|
EXTRACTOR PRO BALLOON RX 9-12MM
|
Facility
OP
|
$550.20
|
|
| Hospital Charge Code |
64904278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.57 |
| Max. Negotiated Rate |
$440.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.10
|
| Rate for Payer: Aetna Government |
$275.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.14
|
| Rate for Payer: Group Health Inc Commercial |
$275.10
|
| Rate for Payer: Group Health Inc Medicare |
$192.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.10
|
|
|
EXTRACTOR,STAPLE PSX PROXIMATE
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
64901615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
|
|
EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
IP
|
$29,602.42
|
|
|
Service Code
|
MS-DRG 115
|
| Min. Negotiated Rate |
$13,414.70 |
| Max. Negotiated Rate |
$29,602.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,067.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,021.98
|
| Rate for Payer: Aetna Government |
$29,021.98
|
| Rate for Payer: Brighton Health Commercial |
$22,683.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,602.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,015.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,294.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,570.88
|
| Rate for Payer: EmblemHealth Commercial |
$13,414.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,021.98
|
| Rate for Payer: Group Health Inc Commercial |
$29,021.98
|
| Rate for Payer: Group Health Inc Medicare |
$29,021.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,021.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,495.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,021.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,021.98
|
| Rate for Payer: Wellcare Medicare |
$27,570.88
|
|
|
EXTRAORAL- EACH ADDITIONAL FILM
|
Facility
OP
|
$31.19
|
|
|
Service Code
|
HCPCS D0260
|
| Hospital Charge Code |
42300704
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.60
|
| Rate for Payer: Aetna Government |
$15.60
|
| 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 |
$15.60
|
| Rate for Payer: Group Health Inc Medicare |
$10.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.60
|
|
|
EXTRAORAL-FIRST FILM
|
Facility
OP
|
$62.50
|
|
|
Service Code
|
HCPCS D0250
|
| Hospital Charge Code |
42300130
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| 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: Elderplan Medicare Advantage |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$105.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$105.08
|
| Rate for Payer: Group Health Inc Medicare |
$105.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.32
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
EXTRAORAL POSTERIOR IMAGE
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
HCPCS D0251
|
| Hospital Charge Code |
42303460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| 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: Elderplan Medicare Advantage |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$105.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$105.08
|
| Rate for Payer: Group Health Inc Medicare |
$105.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.32
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE
|
Facility
IP
|
$103,615.73
|
|
|
Service Code
|
MS-DRG 790
|
| Min. Negotiated Rate |
$42,098.10 |
| Max. Negotiated Rate |
$103,615.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88,471.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$90,533.54
|
| Rate for Payer: Aetna Government |
$90,533.54
|
| Rate for Payer: Brighton Health Commercial |
$87,001.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92,344.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$103,615.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85,508.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$86,006.86
|
| Rate for Payer: EmblemHealth Commercial |
$51,450.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$90,533.54
|
| Rate for Payer: Group Health Inc Commercial |
$90,533.54
|
| Rate for Payer: Group Health Inc Medicare |
$90,533.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90,533.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42,098.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90,533.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90,533.54
|
| Rate for Payer: Wellcare Medicare |
$86,006.86
|
|
|
EXTREMITY STUDY
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 93922 TC
|
| Hospital Charge Code |
30303129
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$78.29 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Government |
$165.12
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.29
|
| Rate for Payer: Group Health Inc Commercial |
$165.12
|
| Rate for Payer: Group Health Inc Medicare |
$115.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.99
|
|
|
EXT RX RETRI BALLN 12.0-15.0MM D
|
Facility
OP
|
$418.00
|
|
| Hospital Charge Code |
40200544
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$229.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.00
|
| Rate for Payer: Aetna Government |
$209.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$334.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.24
|
| Rate for Payer: Group Health Inc Commercial |
$209.00
|
| Rate for Payer: Group Health Inc Medicare |
$146.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.00
|
|
|
EXT RX RETRI BALLN12.0-15.0MMPROX
|
Facility
OP
|
$418.00
|
|
| Hospital Charge Code |
40200545
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$334.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$229.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.00
|
| Rate for Payer: Aetna Government |
$209.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$334.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.24
|
| Rate for Payer: Group Health Inc Commercial |
$209.00
|
| Rate for Payer: Group Health Inc Medicare |
$146.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.00
|
|
|
EXT RX RETRI BALLN 15.0-18.0DIST
|
Facility
OP
|
$398.00
|
|
| Hospital Charge Code |
40200546
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.30 |
| Max. Negotiated Rate |
$318.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$199.00
|
| Rate for Payer: Aetna Government |
$199.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.64
|
| Rate for Payer: Group Health Inc Commercial |
$199.00
|
| Rate for Payer: Group Health Inc Medicare |
$139.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.00
|
|
|
EXT RX RETRI BALLN 15.0-18.0 PROX
|
Facility
OP
|
$398.00
|
|
| Hospital Charge Code |
40200547
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.30 |
| Max. Negotiated Rate |
$318.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$199.00
|
| Rate for Payer: Aetna Government |
$199.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.64
|
| Rate for Payer: Group Health Inc Commercial |
$199.00
|
| Rate for Payer: Group Health Inc Medicare |
$139.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.00
|
|
|
EXT RX RETRI BALLN 9.0-12.0MM DIS
|
Facility
OP
|
$398.00
|
|
| Hospital Charge Code |
40200548
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.30 |
| Max. Negotiated Rate |
$318.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$199.00
|
| Rate for Payer: Aetna Government |
$199.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.64
|
| Rate for Payer: Group Health Inc Commercial |
$199.00
|
| Rate for Payer: Group Health Inc Medicare |
$139.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.00
|
|
|
EXT RX RETRI BALLN 9.0-12.0MMPROX
|
Facility
OP
|
$398.00
|
|
| Hospital Charge Code |
40200549
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.30 |
| Max. Negotiated Rate |
$318.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$199.00
|
| Rate for Payer: Aetna Government |
$199.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.64
|
| Rate for Payer: Group Health Inc Commercial |
$199.00
|
| Rate for Payer: Group Health Inc Medicare |
$139.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.00
|
|
|
EXTUBATION/TUBE REPOSITION
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
40302400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.34 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| 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 |
$285.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| Rate for Payer: Group Health Inc Commercial |
$285.81
|
| Rate for Payer: Group Health Inc Medicare |
$285.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.94
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
|
EYE EXAM 12MONTHS BEFORE SURGERY
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 2020F
|
| Hospital Charge Code |
30300361
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: 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 |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
