|
DIRECT REFER HOSPITAL OBSERVATION
|
Facility
|
IP
|
$1,528.03
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
30000130
|
|
Hospital Revenue Code
|
762
|
| Rate for Payer: Cash Price |
$742.78
|
|
|
DIRECT REFER HOSPITAL OBSERVATION
|
Facility
|
OP
|
$1,528.03
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
30000130
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$594.22 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$835.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$742.78
|
| Rate for Payer: Aetna Government |
$742.78
|
| Rate for Payer: Brighton Health Commercial |
$1,927.00
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$742.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,983.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,685.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$742.78
|
| Rate for Payer: EmblemHealth Commercial |
$742.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.78
|
| Rate for Payer: Group Health Inc Commercial |
$742.78
|
| Rate for Payer: Group Health Inc Medicare |
$742.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$742.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,500.00
|
| Rate for Payer: Humana Medicare |
$757.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.78
|
| Rate for Payer: United Healthcare Commercial |
$2,278.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$742.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$594.22
|
| Rate for Payer: Wellcare Medicare |
$705.64
|
|
|
DIR MEAS GAUGE F/WIRES 1.4X2.0MM
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40200534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$187.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$204.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$170.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$195.50
|
| Rate for Payer: EmblemHealth Commercial |
$170.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$357.00
|
| Rate for Payer: Group Health Inc Commercial |
$170.00
|
| Rate for Payer: Group Health Inc Medicare |
$119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.00
|
|
|
DIR MEAS GAUGE F/WIRES 1.4X2.0MM
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40200534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.00
|
|
|
DISC REPAIR
|
Facility
|
OP
|
$2,610.00
|
|
|
Service Code
|
HCPCS D7852
|
| Hospital Charge Code |
42301965
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$913.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,435.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,783.16
|
| Rate for Payer: Aetna Government |
$1,783.16
|
| Rate for Payer: Brighton Health Commercial |
$1,957.50
|
| 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: Group Health Inc Commercial |
$1,305.00
|
| Rate for Payer: Group Health Inc Medicare |
$913.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,305.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,305.00
|
|
|
DISINFECTANT SPRAY COVERAGE HB
|
Facility
|
OP
|
$110.00
|
|
| Hospital Charge Code |
40209796
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.00
|
| Rate for Payer: Aetna Government |
$55.00
|
| Rate for Payer: Brighton Health Commercial |
$82.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$88.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.80
|
| Rate for Payer: Group Health Inc Commercial |
$55.00
|
| Rate for Payer: Group Health Inc Medicare |
$38.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.00
|
|
|
DISK SPACER ACCOLADE
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
64905994
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Brighton Health Commercial |
$337.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$28,218.64
|
|
|
Service Code
|
MSDRG 442
|
| Min. Negotiated Rate |
$8,159.11 |
| Max. Negotiated Rate |
$28,218.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,029.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,522.65
|
| Rate for Payer: Aetna Government |
$20,522.65
|
| Rate for Payer: Brighton Health Commercial |
$13,796.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,933.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,431.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,559.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,496.52
|
| Rate for Payer: EmblemHealth Commercial |
$8,159.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,522.65
|
| Rate for Payer: Group Health Inc Commercial |
$20,522.65
|
| Rate for Payer: Group Health Inc Medicare |
$20,522.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,522.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,543.03
|
| Rate for Payer: Humana Medicare |
$28,218.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,522.65
|
| Rate for Payer: United Healthcare Commercial |
$18,922.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,522.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,522.65
|
| Rate for Payer: Wellcare Medicare |
$19,496.52
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$44,935.28
|
|
|
Service Code
|
MSDRG 441
|
| Min. Negotiated Rate |
$15,196.29 |
| Max. Negotiated Rate |
$44,935.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,956.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,680.20
|
| Rate for Payer: Aetna Government |
$32,680.20
|
| Rate for Payer: Brighton Health Commercial |
$26,508.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,333.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,571.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,053.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,046.19
|
| Rate for Payer: EmblemHealth Commercial |
$15,676.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,680.20
|
| Rate for Payer: Group Health Inc Commercial |
$32,680.20
|
| Rate for Payer: Group Health Inc Medicare |
$32,680.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,680.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,196.29
|
| Rate for Payer: Humana Medicare |
$44,935.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,680.20
|
| Rate for Payer: United Healthcare Commercial |
$36,357.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,680.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,680.20
|
| Rate for Payer: Wellcare Medicare |
$31,046.19
|
|
|
DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$23,703.43
|
|
|
Service Code
|
MSDRG 443
|
| Min. Negotiated Rate |
$6,128.55 |
| Max. Negotiated Rate |
$23,703.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,538.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,238.86
|
| Rate for Payer: Aetna Government |
$17,238.86
|
| Rate for Payer: Brighton Health Commercial |
$10,363.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,583.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,342.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,185.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,376.92
|
| Rate for Payer: EmblemHealth Commercial |
$6,128.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,238.86
|
| Rate for Payer: Group Health Inc Commercial |
$17,238.86
|
| Rate for Payer: Group Health Inc Medicare |
$17,238.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,238.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,016.07
|
| Rate for Payer: Humana Medicare |
$23,703.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,238.86
|
| Rate for Payer: United Healthcare Commercial |
$14,213.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,238.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,238.86
|
| Rate for Payer: Wellcare Medicare |
$16,376.92
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC
|
Facility
|
IP
|
$26,382.44
|
|
|
Service Code
|
MSDRG 439
|
| Min. Negotiated Rate |
$7,333.34 |
| Max. Negotiated Rate |
$26,382.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,609.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,187.23
|
| Rate for Payer: Aetna Government |
$19,187.23
|
| Rate for Payer: Brighton Health Commercial |
$12,400.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,570.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,768.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,187.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,227.87
|
| Rate for Payer: EmblemHealth Commercial |
$7,333.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,187.23
|
| Rate for Payer: Group Health Inc Commercial |
$19,187.23
|
| Rate for Payer: Group Health Inc Medicare |
$19,187.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,187.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,922.06
|
| Rate for Payer: Humana Medicare |
$26,382.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,187.23
|
| Rate for Payer: United Healthcare Commercial |
$17,007.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,187.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,187.23
|
| Rate for Payer: Wellcare Medicare |
$18,227.87
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$41,895.88
|
|
|
Service Code
|
MSDRG 438
|
| Min. Negotiated Rate |
$14,168.42 |
| Max. Negotiated Rate |
$41,895.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,606.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,469.73
|
| Rate for Payer: Aetna Government |
$30,469.73
|
| Rate for Payer: Brighton Health Commercial |
$24,197.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,079.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,818.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,782.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,946.24
|
| Rate for Payer: EmblemHealth Commercial |
$14,310.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,469.73
|
| Rate for Payer: Group Health Inc Commercial |
$30,469.73
|
| Rate for Payer: Group Health Inc Medicare |
$30,469.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,469.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,168.42
|
| Rate for Payer: Humana Medicare |
$41,895.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,469.73
|
| Rate for Payer: United Healthcare Commercial |
$33,187.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,469.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,469.73
|
| Rate for Payer: Wellcare Medicare |
$28,946.24
|
|
|
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$21,813.84
|
|
|
Service Code
|
MSDRG 440
|
| Min. Negotiated Rate |
$5,278.77 |
| Max. Negotiated Rate |
$21,813.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,077.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,864.61
|
| Rate for Payer: Aetna Government |
$15,864.61
|
| Rate for Payer: Brighton Health Commercial |
$8,926.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,181.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10,630.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,772.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,071.38
|
| Rate for Payer: EmblemHealth Commercial |
$5,278.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,864.61
|
| Rate for Payer: Group Health Inc Commercial |
$15,864.61
|
| Rate for Payer: Group Health Inc Medicare |
$15,864.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,864.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,377.04
|
| Rate for Payer: Humana Medicare |
$21,813.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,864.61
|
| Rate for Payer: United Healthcare Commercial |
$12,242.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,864.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,864.61
|
| Rate for Payer: Wellcare Medicare |
$15,071.38
|
|
|
DISORDERS OF PERSONALITY AND IMPULSE CONTROL
|
Facility
|
IP
|
$45,835.28
|
|
|
Service Code
|
MSDRG 883
|
| Min. Negotiated Rate |
$905.00 |
| Max. Negotiated Rate |
$45,835.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,859.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,334.75
|
| Rate for Payer: Aetna Government |
$33,334.75
|
| Rate for Payer: Brighton Health Commercial |
$27,193.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34,001.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32,386.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,726.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,668.01
|
| Rate for Payer: EmblemHealth Commercial |
$905.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,334.75
|
| Rate for Payer: Group Health Inc Commercial |
$33,334.75
|
| Rate for Payer: Group Health Inc Medicare |
$33,334.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,334.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,500.66
|
| Rate for Payer: Humana Medicare |
$45,835.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,334.75
|
| Rate for Payer: United Healthcare Commercial |
$37,296.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,334.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,334.75
|
| Rate for Payer: Wellcare Medicare |
$31,668.01
|
|
|
DISORDERS OF THE BILIARY TRACT WITH CC
|
Facility
|
IP
|
$30,798.52
|
|
|
Service Code
|
MSDRG 445
|
| Min. Negotiated Rate |
$9,319.31 |
| Max. Negotiated Rate |
$30,798.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,024.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,398.92
|
| Rate for Payer: Aetna Government |
$22,398.92
|
| Rate for Payer: Brighton Health Commercial |
$15,758.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,846.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,767.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,488.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,278.97
|
| Rate for Payer: EmblemHealth Commercial |
$9,319.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,398.92
|
| Rate for Payer: Group Health Inc Commercial |
$22,398.92
|
| Rate for Payer: Group Health Inc Medicare |
$22,398.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,398.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,415.50
|
| Rate for Payer: Humana Medicare |
$30,798.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,398.92
|
| Rate for Payer: United Healthcare Commercial |
$21,613.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,398.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,398.92
|
| Rate for Payer: Wellcare Medicare |
$21,278.97
|
|
|
DISORDERS OF THE BILIARY TRACT WITH MCC
|
Facility
|
IP
|
$41,217.08
|
|
|
Service Code
|
MSDRG 444
|
| Min. Negotiated Rate |
$13,938.87 |
| Max. Negotiated Rate |
$41,217.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,081.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,976.06
|
| Rate for Payer: Aetna Government |
$29,976.06
|
| Rate for Payer: Brighton Health Commercial |
$23,681.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,575.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,203.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,274.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,477.26
|
| Rate for Payer: EmblemHealth Commercial |
$14,004.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,976.06
|
| Rate for Payer: Group Health Inc Commercial |
$29,976.06
|
| Rate for Payer: Group Health Inc Medicare |
$29,976.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,976.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,938.87
|
| Rate for Payer: Humana Medicare |
$41,217.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,976.06
|
| Rate for Payer: United Healthcare Commercial |
$32,479.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,976.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,976.06
|
| Rate for Payer: Wellcare Medicare |
$28,477.26
|
|
|
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC
|
Facility
|
IP
|
$25,358.51
|
|
|
Service Code
|
MSDRG 446
|
| Min. Negotiated Rate |
$6,872.86 |
| Max. Negotiated Rate |
$25,358.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,818.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,442.55
|
| Rate for Payer: Aetna Government |
$18,442.55
|
| Rate for Payer: Brighton Health Commercial |
$11,621.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,811.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,841.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,422.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,520.42
|
| Rate for Payer: EmblemHealth Commercial |
$6,872.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,442.55
|
| Rate for Payer: Group Health Inc Commercial |
$18,442.55
|
| Rate for Payer: Group Health Inc Medicare |
$18,442.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,442.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,575.79
|
| Rate for Payer: Humana Medicare |
$25,358.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,442.55
|
| Rate for Payer: United Healthcare Commercial |
$15,939.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,442.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,442.55
|
| Rate for Payer: Wellcare Medicare |
$17,520.42
|
|
|
DISP KIT FOR 2.9MM PUSHLOCK
|
Facility
|
OP
|
$625.00
|
|
| Hospital Charge Code |
64903563
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$343.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.50
|
| Rate for Payer: Aetna Government |
$312.50
|
| Rate for Payer: Brighton Health Commercial |
$468.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$425.00
|
| Rate for Payer: Group Health Inc Commercial |
$312.50
|
| Rate for Payer: Group Health Inc Medicare |
$218.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.50
|
|
|
DISPOSABLE CUFF 24IN ORTHO SURG
|
Facility
|
OP
|
$640.00
|
|
| Hospital Charge Code |
64905103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$352.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$320.00
|
| Rate for Payer: Aetna Government |
$320.00
|
| Rate for Payer: Brighton Health Commercial |
$480.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$512.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$435.20
|
| Rate for Payer: Group Health Inc Commercial |
$320.00
|
| Rate for Payer: Group Health Inc Medicare |
$224.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.00
|
|
|
DISPOSABLE CUSION CONTOURED FOAM
|
Facility
|
OP
|
$150.53
|
|
| Hospital Charge Code |
64905193
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.69 |
| Max. Negotiated Rate |
$120.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.26
|
| Rate for Payer: Aetna Government |
$75.26
|
| Rate for Payer: Brighton Health Commercial |
$112.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.36
|
| Rate for Payer: Group Health Inc Commercial |
$75.26
|
| Rate for Payer: Group Health Inc Medicare |
$52.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.26
|
|
|
DISPOSABLE HEADLESS PINS
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$475.00
|
|
|
DISPOSABLE HEADLESS PINS
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$997.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$522.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$570.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$475.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$546.25
|
| Rate for Payer: EmblemHealth Commercial |
$475.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$997.50
|
| Rate for Payer: Group Health Inc Commercial |
$475.00
|
| Rate for Payer: Group Health Inc Medicare |
$332.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$475.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$617.50
|
|
|
DISPOSABLE KIT ACL ALL
|
Facility
|
OP
|
$1,182.50
|
|
| Hospital Charge Code |
64905868
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$413.88 |
| Max. Negotiated Rate |
$946.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$650.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$591.25
|
| Rate for Payer: Aetna Government |
$591.25
|
| Rate for Payer: Brighton Health Commercial |
$886.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$946.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$804.10
|
| Rate for Payer: Group Health Inc Commercial |
$591.25
|
| Rate for Payer: Group Health Inc Medicare |
$413.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.25
|
|
|
DISPOSABLE SIGMOIDOSCOPE
|
Facility
|
OP
|
$12.05
|
|
| Hospital Charge Code |
40201217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Brighton Health Commercial |
$9.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
DISPOSABLES KIT T3
|
Facility
|
OP
|
$1,782.50
|
|
| Hospital Charge Code |
64905871
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$623.88 |
| Max. Negotiated Rate |
$1,426.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$980.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$891.25
|
| Rate for Payer: Aetna Government |
$891.25
|
| Rate for Payer: Brighton Health Commercial |
$1,336.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,426.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,212.10
|
| Rate for Payer: Group Health Inc Commercial |
$891.25
|
| Rate for Payer: Group Health Inc Medicare |
$623.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$891.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$891.25
|
|
