|
AMYLASE_ISOENZYMES
|
Facility
OP
|
$16.20
|
|
|
Service Code
|
HCPCS 82150
|
| Hospital Charge Code |
40609042
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.48
|
| Rate for Payer: Aetna Government |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.48
|
| Rate for Payer: EmblemHealth Commercial |
$6.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.77
|
| Rate for Payer: Group Health Inc Commercial |
$6.48
|
| Rate for Payer: Group Health Inc Medicare |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.48
|
| Rate for Payer: Healthfirst QHP |
$6.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.83
|
|
|
AMYL NITRATE 0.3ML INHALANT
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41641280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
AMYL NITRATE 0.3ML INHALANT
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41651280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
AMYL NITRITE + NA NITRITE + NA THIOSULFA
|
Facility
OP
|
$670.00
|
|
| Hospital Charge Code |
41644024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$368.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$335.00
|
| Rate for Payer: Aetna Government |
$335.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$536.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$455.60
|
| Rate for Payer: Group Health Inc Commercial |
$335.00
|
| Rate for Payer: Group Health Inc Medicare |
$234.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$335.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$335.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$435.50
|
|
|
AMYL NITRITE + NA NITRITE + NA THIOSULFA
|
Facility
OP
|
$670.00
|
|
| Hospital Charge Code |
41654024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$368.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$335.00
|
| Rate for Payer: Aetna Government |
$335.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$536.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$455.60
|
| Rate for Payer: Group Health Inc Commercial |
$335.00
|
| Rate for Payer: Group Health Inc Medicare |
$234.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$335.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$335.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$435.50
|
|
|
ANA CROWN EXP 4 OR > PER QUAD
|
Facility
OP
|
$600.00
|
|
|
Service Code
|
HCPCS D4230
|
| Hospital Charge Code |
42303420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$3,723.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$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: EmblemHealth Commercial |
$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 |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| 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: Senior Whole Health 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
|
|
|
ANAEROBIC AND AEROBIC CULTURE
|
Facility
OP
|
$79.88
|
|
| Hospital Charge Code |
40614219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.96 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.94
|
| Rate for Payer: Aetna Government |
$39.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.32
|
| Rate for Payer: Group Health Inc Commercial |
$39.94
|
| Rate for Payer: Group Health Inc Medicare |
$27.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.94
|
|
|
ANAEROBIC CULTURE
|
Facility
OP
|
$21.55
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
40614005
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$13.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.90
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
IP
|
$25,882.36
|
|
|
Service Code
|
MS-DRG 348
|
| Min. Negotiated Rate |
$11,159.50 |
| Max. Negotiated Rate |
$25,882.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,189.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,374.86
|
| Rate for Payer: Aetna Government |
$25,374.86
|
| Rate for Payer: Brighton Health Commercial |
$18,870.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,882.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,473.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,546.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,106.12
|
| Rate for Payer: EmblemHealth Commercial |
$11,159.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,374.86
|
| Rate for Payer: Group Health Inc Commercial |
$25,374.86
|
| Rate for Payer: Group Health Inc Medicare |
$25,374.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,374.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,799.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,374.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,374.86
|
| Rate for Payer: Wellcare Medicare |
$24,106.12
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
IP
|
$44,020.41
|
|
|
Service Code
|
MS-DRG 347
|
| Min. Negotiated Rate |
$19,844.90 |
| Max. Negotiated Rate |
$44,020.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37,586.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42,677.20
|
| Rate for Payer: Aetna Government |
$42,677.20
|
| Rate for Payer: Brighton Health Commercial |
$36,961.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43,530.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44,020.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36,327.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$40,543.34
|
| Rate for Payer: EmblemHealth Commercial |
$21,858.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$42,677.20
|
| Rate for Payer: Group Health Inc Commercial |
$42,677.20
|
| Rate for Payer: Group Health Inc Medicare |
$42,677.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42,677.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,844.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42,677.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42,677.20
|
| Rate for Payer: Wellcare Medicare |
$40,543.34
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$21,276.83
|
|
|
Service Code
|
MS-DRG 349
|
| Min. Negotiated Rate |
$8,367.49 |
| Max. Negotiated Rate |
$21,276.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,388.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,859.64
|
| Rate for Payer: Aetna Government |
$20,859.64
|
| Rate for Payer: Brighton Health Commercial |
$14,149.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,276.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,851.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,906.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,816.66
|
| Rate for Payer: EmblemHealth Commercial |
$8,367.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,859.64
|
| Rate for Payer: Group Health Inc Commercial |
$20,859.64
|
| Rate for Payer: Group Health Inc Medicare |
$20,859.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,859.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,699.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,859.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,859.64
|
| Rate for Payer: Wellcare Medicare |
$19,816.66
|
|
|
ANAL DILATATION
|
Facility
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 46604
|
| Hospital Charge Code |
40011155
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,364.66
|
| Rate for Payer: Aetna Government |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,364.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,364.66
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,364.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.55
|
| Rate for Payer: Group Health Inc Commercial |
$1,364.66
|
| Rate for Payer: Group Health Inc Medicare |
$1,364.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,159.96
|
| Rate for Payer: Healthfirst QHP |
$1,364.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,364.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,364.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,091.73
|
| Rate for Payer: Wellcare Medicare |
$1,296.43
|
|
|
ANALGESIA
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
HCPCS D9230
|
| Hospital Charge Code |
42302315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$9,862.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.47
|
| Rate for Payer: Aetna Government |
$17.47
|
| Rate for Payer: Amida Care Medicaid |
$98.62
|
| 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 |
$9,862.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.55
|
| Rate for Payer: Group Health Inc Commercial |
$39.00
|
| Rate for Payer: Group Health Inc Medicare |
$27.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.62
|
| Rate for Payer: Healthfirst Essential Plan |
$221.90
|
| Rate for Payer: Healthfirst QHP |
$98.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.62
|
| Rate for Payer: SOMOS Essential |
$221.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$98.62
|
|
|
ANAL SP INF PUMP W/REGPR &REFILL
|
Facility
OP
|
$820.53
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
30306664
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$345.41
|
| Rate for Payer: Aetna Government |
$345.41
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$345.41
|
| 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 |
$345.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$293.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$345.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$307.41
|
| 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 |
$410.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$293.60
|
| Rate for Payer: Healthfirst QHP |
$345.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$345.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$345.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$345.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$276.33
|
| Rate for Payer: Wellcare Medicare |
$328.14
|
|
|
ANALYZE NEUROSTIM
|
Facility
OP
|
$343.55
|
|
|
Service Code
|
HCPCS 95971
|
| Hospital Charge Code |
30305506
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$274.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.94
|
| Rate for Payer: Aetna Government |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$111.94
|
| Rate for Payer: EmblemHealth Commercial |
$111.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.63
|
| Rate for Payer: Group Health Inc Commercial |
$111.94
|
| Rate for Payer: Group Health Inc Medicare |
$111.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.15
|
| Rate for Payer: Healthfirst QHP |
$111.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$89.55
|
| Rate for Payer: Wellcare Medicare |
$106.34
|
|
|
ANALYZE NEUROSTIM COMPLEX
|
Facility
OP
|
$343.55
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
30305956
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$274.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.94
|
| Rate for Payer: Aetna Government |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$111.94
|
| Rate for Payer: EmblemHealth Commercial |
$111.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.63
|
| Rate for Payer: Group Health Inc Commercial |
$111.94
|
| Rate for Payer: Group Health Inc Medicare |
$111.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.15
|
| Rate for Payer: Healthfirst QHP |
$111.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$89.55
|
| Rate for Payer: Wellcare Medicare |
$106.34
|
|
|
ANASTAMOSIS COLO-ANAL
|
Facility
OP
|
$5,042.05
|
|
|
Service Code
|
HCPCS 45119
|
| Hospital Charge Code |
40019629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,773.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,275.14
|
| Rate for Payer: Aetna Government |
$2,275.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,043.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,521.02
|
| Rate for Payer: Group Health Inc Medicare |
$1,764.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,521.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,521.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,270.55
|
|
|
ANASTROZOLE 1 MG TAB
|
Facility
IP
|
$1.16
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41642393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
|
|
ANASTROZOLE 1 MG TAB
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41652393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
ANASTROZOLE 1 MG TAB
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41642393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
ANASTROZOLE 1 MG TAB
|
Facility
IP
|
$1.16
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41652393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
|
|
ANCA PANEL
|
Facility
OP
|
$43.18
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
40609093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.82
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
ANCHOR
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$275.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$316.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$577.50
|
| Rate for Payer: Group Health Inc Commercial |
$275.00
|
| Rate for Payer: Group Health Inc Medicare |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.50
|
|
|
ANCHOR
|
Facility
IP
|
$458.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209648
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.00 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.00
|
|
|
ANCHOR
|
Facility
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209639
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.00
|
|
