|
DENGUE VIRUS IGG AND IGM
|
Facility
|
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
40729388
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.15
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
DENGUE VIRUS IGG AND IGM
|
Facility
|
IP
|
$32.20
|
|
|
Service Code
|
HCPCS 86790
|
| Hospital Charge Code |
40729388
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.88
|
|
|
DENOSUMAB 120 MG/1.7ML SC SOLN [106804]
|
Facility
|
OP
|
$2,254.89
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
55513073001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$1,803.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,240.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.20
|
| Rate for Payer: Aetna Government |
$25.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.64
|
| Rate for Payer: Brighton Health Commercial |
$1,691.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,803.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,533.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.20
|
| Rate for Payer: EmblemHealth Commercial |
$25.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.43
|
| Rate for Payer: Group Health Inc Commercial |
$25.20
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,127.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.42
|
| Rate for Payer: Healthfirst QHP |
$25.20
|
| Rate for Payer: Humana Medicare |
$25.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,465.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.16
|
| Rate for Payer: Wellcare Medicare |
$23.94
|
|
|
DENOSUMAB 60 MG/1ML INJ
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41647018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
|
|
DENOSUMAB 60 MG/1ML INJ
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41647018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.20
|
| Rate for Payer: Aetna Government |
$25.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.64
|
| Rate for Payer: Brighton Health Commercial |
$29.40
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.20
|
| Rate for Payer: EmblemHealth Commercial |
$25.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.46
|
| Rate for Payer: Group Health Inc Commercial |
$25.20
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.42
|
| Rate for Payer: Healthfirst QHP |
$25.20
|
| Rate for Payer: Humana Medicare |
$25.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.70
|
| Rate for Payer: SOMOS Essential |
$26.70
|
| Rate for Payer: United Healthcare Commercial |
$23.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.16
|
| Rate for Payer: Wellcare Medicare |
$23.94
|
|
|
DENOSUMAB 60MG/1ML INJ
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41657018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
|
|
DENOSUMAB 60MG/1ML INJ
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41657018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.20
|
| Rate for Payer: Aetna Government |
$25.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.64
|
| Rate for Payer: Brighton Health Commercial |
$29.40
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.20
|
| Rate for Payer: EmblemHealth Commercial |
$25.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.46
|
| Rate for Payer: Group Health Inc Commercial |
$25.20
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.42
|
| Rate for Payer: Healthfirst QHP |
$25.20
|
| Rate for Payer: Humana Medicare |
$25.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.70
|
| Rate for Payer: SOMOS Essential |
$26.70
|
| Rate for Payer: United Healthcare Commercial |
$23.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.16
|
| Rate for Payer: Wellcare Medicare |
$23.94
|
|
|
DENOSUMAB 60 MG/ML SC SOSY [166256]
|
Facility
|
OP
|
$2,083.96
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
55513071001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$1,667.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,146.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.20
|
| Rate for Payer: Aetna Government |
$25.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.64
|
| Rate for Payer: Brighton Health Commercial |
$1,562.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,667.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,417.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.20
|
| Rate for Payer: EmblemHealth Commercial |
$25.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.43
|
| Rate for Payer: Group Health Inc Commercial |
$25.20
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,041.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.42
|
| Rate for Payer: Healthfirst QHP |
$25.20
|
| Rate for Payer: Humana Medicare |
$25.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,354.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.16
|
| Rate for Payer: Wellcare Medicare |
$23.94
|
|
|
DENTAL AND ORAL DISEASES WITH CC
|
Facility
|
IP
|
$27,970.77
|
|
|
Service Code
|
MSDRG 158
|
| Min. Negotiated Rate |
$8,047.64 |
| Max. Negotiated Rate |
$27,970.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,838.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,342.38
|
| Rate for Payer: Aetna Government |
$20,342.38
|
| Rate for Payer: Brighton Health Commercial |
$13,608.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,749.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,206.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,374.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,325.26
|
| Rate for Payer: EmblemHealth Commercial |
$8,047.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,342.38
|
| Rate for Payer: Group Health Inc Commercial |
$20,342.38
|
| Rate for Payer: Group Health Inc Medicare |
$20,342.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,342.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,459.21
|
| Rate for Payer: Humana Medicare |
$27,970.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,342.38
|
| Rate for Payer: United Healthcare Commercial |
$18,663.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,342.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,342.38
|
| Rate for Payer: Wellcare Medicare |
$19,325.26
|
|
|
DENTAL AND ORAL DISEASES WITH MCC
|
Facility
|
IP
|
$42,624.27
|
|
|
Service Code
|
MSDRG 157
|
| Min. Negotiated Rate |
$14,414.75 |
| Max. Negotiated Rate |
$42,624.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25,169.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,999.47
|
| Rate for Payer: Aetna Government |
$30,999.47
|
| Rate for Payer: Brighton Health Commercial |
$24,751.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,619.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,478.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,326.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,449.50
|
| Rate for Payer: EmblemHealth Commercial |
$14,637.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,999.47
|
| Rate for Payer: Group Health Inc Commercial |
$30,999.47
|
| Rate for Payer: Group Health Inc Medicare |
$30,999.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,999.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,414.75
|
| Rate for Payer: Humana Medicare |
$42,624.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,999.47
|
| Rate for Payer: United Healthcare Commercial |
$33,947.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,999.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,999.47
|
| Rate for Payer: Wellcare Medicare |
$29,449.50
|
|
|
DENTAL AND ORAL DISEASES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,950.28
|
|
|
Service Code
|
MSDRG 159
|
| Min. Negotiated Rate |
$5,789.84 |
| Max. Negotiated Rate |
$22,950.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,955.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,691.11
|
| Rate for Payer: Aetna Government |
$16,691.11
|
| Rate for Payer: Brighton Health Commercial |
$9,790.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,024.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,660.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,622.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,856.55
|
| Rate for Payer: EmblemHealth Commercial |
$5,789.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,691.11
|
| Rate for Payer: Group Health Inc Commercial |
$16,691.11
|
| Rate for Payer: Group Health Inc Medicare |
$16,691.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,691.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,761.37
|
| Rate for Payer: Humana Medicare |
$22,950.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,691.11
|
| Rate for Payer: United Healthcare Commercial |
$13,427.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,691.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,691.11
|
| Rate for Payer: Wellcare Medicare |
$15,856.55
|
|
|
DENTAL CASE MGMT SPECIAL NEEDS
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS D9997
|
| Hospital Charge Code |
42301001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.75 |
| Max. Negotiated Rate |
$6,575.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.00
|
| Rate for Payer: Aetna Government |
$265.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$147.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$147.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$65.75
|
| Rate for Payer: Amida Care Medicaid |
$65.75
|
| Rate for Payer: Brighton Health Commercial |
$397.50
|
| 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 |
$6,575.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.04
|
| Rate for Payer: Group Health Inc Commercial |
$265.00
|
| Rate for Payer: Group Health Inc Medicare |
$185.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$265.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.75
|
| Rate for Payer: Healthfirst Essential Plan |
$147.94
|
| Rate for Payer: Healthfirst QHP |
$65.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.75
|
| Rate for Payer: SOMOS Essential |
$147.94
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$147.94
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$72.32
|
| Rate for Payer: United Healthcare Medicaid |
$65.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.75
|
|
|
DENTAL GUARD
|
Facility
|
OP
|
$10.82
|
|
| Hospital Charge Code |
64904309
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.41
|
| Rate for Payer: Aetna Government |
$5.41
|
| Rate for Payer: Brighton Health Commercial |
$8.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.36
|
| Rate for Payer: Group Health Inc Commercial |
$5.41
|
| Rate for Payer: Group Health Inc Medicare |
$3.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.41
|
|
|
DENTAL SURGERY
|
Facility
|
OP
|
$651.23
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
42301002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.98 |
| Max. Negotiated Rate |
$142,987.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,217.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,217.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,429.87
|
| Rate for Payer: Amida Care Medicaid |
$1,429.87
|
| Rate for Payer: Brighton Health Commercial |
$488.42
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$282.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142,987.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,429.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,429.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,501.36
|
| Rate for Payer: Group Health Inc Commercial |
$282.47
|
| Rate for Payer: Group Health Inc Medicare |
$282.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,429.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,429.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,217.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$1,429.87
|
| Rate for Payer: Humana Medicare |
$288.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,429.87
|
| Rate for Payer: SOMOS Essential |
$3,217.21
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,217.21
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,572.86
|
| Rate for Payer: United Healthcare Medicaid |
$1,429.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
DENTAL SURGERY
|
Facility
|
IP
|
$651.23
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
42301002
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
DEPRESSIVE NEUROSES
|
Facility
|
IP
|
$20,296.58
|
|
|
Service Code
|
MSDRG 881
|
| Min. Negotiated Rate |
$905.00 |
| Max. Negotiated Rate |
$20,296.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,859.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,898.61
|
| Rate for Payer: Aetna Government |
$19,898.61
|
| Rate for Payer: Brighton Health Commercial |
$13,144.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,296.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,654.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,918.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,903.68
|
| Rate for Payer: EmblemHealth Commercial |
$905.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,898.61
|
| Rate for Payer: Group Health Inc Commercial |
$19,898.61
|
| Rate for Payer: Group Health Inc Medicare |
$19,898.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,898.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,252.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,898.61
|
| Rate for Payer: United Healthcare Commercial |
$18,027.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,898.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,898.61
|
| Rate for Payer: Wellcare Medicare |
$18,903.68
|
|
|
DEPUY 1745-70-000
|
Facility
|
OP
|
$920.00
|
|
| Hospital Charge Code |
40029566
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$506.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$460.00
|
| Rate for Payer: Aetna Government |
$460.00
|
| Rate for Payer: Brighton Health Commercial |
$690.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$736.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$625.60
|
| Rate for Payer: Group Health Inc Commercial |
$460.00
|
| Rate for Payer: Group Health Inc Medicare |
$322.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$460.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.00
|
|
|
DEPUY 7X40MM POLY SCREW
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,126.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,161.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,358.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,965.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,259.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,965.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,126.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,965.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,375.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,965.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,965.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,554.50
|
|
|
DEPUY 7X40MM POLY SCREW
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,965.00 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,965.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,965.00
|
|
|
DEPUY ANGLED HOOK
|
Facility
|
OP
|
$2,050.00
|
|
| Hospital Charge Code |
40024017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,127.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,025.00
|
| Rate for Payer: Aetna Government |
$1,025.00
|
| Rate for Payer: Brighton Health Commercial |
$1,537.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,640.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,394.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,025.00
|
| Rate for Payer: Group Health Inc Medicare |
$717.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,025.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,025.00
|
|
|
DEPUY ANGLED SPR LAM HOOK
|
Facility
|
OP
|
$2,050.00
|
|
| Hospital Charge Code |
40029555
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,127.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,025.00
|
| Rate for Payer: Aetna Government |
$1,025.00
|
| Rate for Payer: Brighton Health Commercial |
$1,537.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,640.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,394.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,025.00
|
| Rate for Payer: Group Health Inc Medicare |
$717.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,025.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,025.00
|
|
|
DEPUY ARTICULEZE HEAD 28-5
|
Facility
|
OP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40029551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,194.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,149.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,254.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,045.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,201.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,045.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,194.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,045.00
|
| Rate for Payer: Group Health Inc Medicare |
$731.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,358.50
|
|
|
DEPUY ARTICULEZE HEAD 28-5
|
Facility
|
IP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40029551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,045.00 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.00
|
|
|
DEPUY ASSEMBLY CONNECTOR TRANSV
|
Facility
|
OP
|
$1,360.00
|
|
| Hospital Charge Code |
40029559
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$748.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$680.00
|
| Rate for Payer: Aetna Government |
$680.00
|
| Rate for Payer: Brighton Health Commercial |
$1,020.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,088.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$924.80
|
| Rate for Payer: Group Health Inc Commercial |
$680.00
|
| Rate for Payer: Group Health Inc Medicare |
$476.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$680.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.00
|
|
|
DEPUY CONDUCT 10CC
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
40029558
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$825.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$750.00
|
| Rate for Payer: Aetna Government |
$750.00
|
| Rate for Payer: Brighton Health Commercial |
$1,125.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,020.00
|
| Rate for Payer: Group Health Inc Commercial |
$750.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.00
|
|
