|
EXTENSION PIECE - GMRS
|
Facility
|
OP
|
$10,211.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$10,721.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,616.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$6,126.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,105.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,871.47
|
| Rate for Payer: EmblemHealth Commercial |
$5,105.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,721.81
|
| Rate for Payer: Group Health Inc Commercial |
$5,105.62
|
| Rate for Payer: Group Health Inc Medicare |
$3,573.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,105.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,637.31
|
|
|
EXTENSION PIECE - GMRS
|
Facility
|
IP
|
$10,211.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907269
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,105.62 |
| Max. Negotiated Rate |
$5,105.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,105.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,105.62
|
|
|
EXTENSION SET/2 INJECT SITES
|
Facility
|
OP
|
$5.09
|
|
| Hospital Charge Code |
64901298
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.54
|
| Rate for Payer: Aetna Government |
$2.54
|
| Rate for Payer: Brighton Health Commercial |
$3.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.46
|
| Rate for Payer: Group Health Inc Commercial |
$2.54
|
| Rate for Payer: Group Health Inc Medicare |
$1.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.54
|
|
|
EXTENSION STEM 14MM DIA LONG 1
|
Facility
|
OP
|
$4,602.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,832.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,531.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,761.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,301.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,646.44
|
| Rate for Payer: EmblemHealth Commercial |
$2,301.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,832.62
|
| Rate for Payer: Group Health Inc Commercial |
$2,301.25
|
| Rate for Payer: Group Health Inc Medicare |
$1,610.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,301.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,301.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,991.62
|
|
|
EXTENSION STEM 14MM DIA LONG 1
|
Facility
|
IP
|
$4,602.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.25 |
| Max. Negotiated Rate |
$2,301.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,301.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,301.25
|
|
|
EXTENSION STEM 18MM DIA LONG 1
|
Facility
|
IP
|
$4,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,240.00
|
|
|
EXTENSION STEM 18MM DIA LONG 1
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904177
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,464.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,688.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,576.00
|
| Rate for Payer: EmblemHealth Commercial |
$2,240.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,704.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,240.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,568.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,240.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,912.00
|
|
|
EXTENSION STEM 20MM DIA LONG 1
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,464.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,688.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,576.00
|
| Rate for Payer: EmblemHealth Commercial |
$2,240.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,704.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,240.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,568.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,240.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,912.00
|
|
|
EXTENSION STEM 20MM DIA LONG 1
|
Facility
|
IP
|
$4,480.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,240.00
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$67,888.88
|
|
|
Service Code
|
MSDRG 933
|
| Min. Negotiated Rate |
$22,958.78 |
| Max. Negotiated Rate |
$67,888.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,706.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49,373.73
|
| Rate for Payer: Aetna Government |
$49,373.73
|
| Rate for Payer: Brighton Health Commercial |
$43,964.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50,361.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52,359.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43,209.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$46,905.04
|
| Rate for Payer: EmblemHealth Commercial |
$25,999.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$49,373.73
|
| Rate for Payer: Group Health Inc Commercial |
$49,373.73
|
| Rate for Payer: Group Health Inc Medicare |
$49,373.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49,373.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22,958.78
|
| Rate for Payer: Humana Medicare |
$67,888.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49,373.73
|
| Rate for Payer: United Healthcare Commercial |
$60,297.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49,373.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49,373.73
|
| Rate for Payer: Wellcare Medicare |
$46,905.04
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
|
IP
|
$524,195.47
|
|
|
Service Code
|
MSDRG 927
|
| Min. Negotiated Rate |
$173,377.14 |
| Max. Negotiated Rate |
$524,195.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388,659.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$372,854.07
|
| Rate for Payer: Aetna Government |
$372,854.07
|
| Rate for Payer: Brighton Health Commercial |
$382,201.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380,311.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$455,188.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375,641.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$354,211.37
|
| Rate for Payer: EmblemHealth Commercial |
$226,026.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$372,854.07
|
| Rate for Payer: Group Health Inc Commercial |
$372,854.07
|
| Rate for Payer: Group Health Inc Medicare |
$372,854.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$372,854.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173,377.14
|
| Rate for Payer: Humana Medicare |
$512,674.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$372,854.07
|
| Rate for Payer: United Healthcare Commercial |
$524,195.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$372,854.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$372,854.07
|
| Rate for Payer: Wellcare Medicare |
$354,211.37
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$57,477.96
|
|
|
Service Code
|
MSDRG 982
|
| Min. Negotiated Rate |
$19,438.00 |
| Max. Negotiated Rate |
$57,477.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36,656.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41,802.15
|
| Rate for Payer: Aetna Government |
$41,802.15
|
| Rate for Payer: Brighton Health Commercial |
$36,047.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42,638.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42,930.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35,428.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$39,712.04
|
| Rate for Payer: EmblemHealth Commercial |
$21,317.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$41,802.15
|
| Rate for Payer: Group Health Inc Commercial |
$41,802.15
|
| Rate for Payer: Group Health Inc Medicare |
$41,802.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41,802.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,438.00
|
| Rate for Payer: Humana Medicare |
$57,477.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41,802.15
|
| Rate for Payer: United Healthcare Commercial |
$49,439.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41,802.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41,802.15
|
| Rate for Payer: Wellcare Medicare |
$39,712.04
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$100,464.07
|
|
|
Service Code
|
MSDRG 981
|
| Min. Negotiated Rate |
$33,975.12 |
| Max. Negotiated Rate |
$100,464.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69,897.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73,064.78
|
| Rate for Payer: Aetna Government |
$73,064.78
|
| Rate for Payer: Brighton Health Commercial |
$68,735.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74,526.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81,861.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67,556.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$69,411.54
|
| Rate for Payer: EmblemHealth Commercial |
$40,648.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$73,064.78
|
| Rate for Payer: Group Health Inc Commercial |
$73,064.78
|
| Rate for Payer: Group Health Inc Medicare |
$73,064.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73,064.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33,975.12
|
| Rate for Payer: Humana Medicare |
$100,464.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73,064.78
|
| Rate for Payer: United Healthcare Commercial |
$94,272.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73,064.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73,064.78
|
| Rate for Payer: Wellcare Medicare |
$69,411.54
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$41,255.21
|
|
|
Service Code
|
MSDRG 983
|
| Min. Negotiated Rate |
$13,951.76 |
| Max. Negotiated Rate |
$41,255.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,111.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,003.79
|
| Rate for Payer: Aetna Government |
$30,003.79
|
| Rate for Payer: Brighton Health Commercial |
$23,710.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,603.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,238.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,303.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,503.60
|
| Rate for Payer: EmblemHealth Commercial |
$14,021.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,003.79
|
| Rate for Payer: Group Health Inc Commercial |
$30,003.79
|
| Rate for Payer: Group Health Inc Medicare |
$30,003.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,003.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,951.76
|
| Rate for Payer: Humana Medicare |
$41,255.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,003.79
|
| Rate for Payer: United Healthcare Commercial |
$32,519.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,003.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,003.79
|
| Rate for Payer: Wellcare Medicare |
$28,503.60
|
|
|
EXTERNAL BLEACHING - PER ARCH
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
HCPCS D9972
|
| Hospital Charge Code |
42303378
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$389.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.53
|
| Rate for Payer: Aetna Government |
$72.53
|
| Rate for Payer: Brighton Health Commercial |
$531.75
|
| 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 |
$354.50
|
| Rate for Payer: Group Health Inc Medicare |
$248.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.50
|
|
|
EXTERNAL BLEACHING - PER TOOTH
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS D9973
|
| Hospital Charge Code |
42303379
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.06
|
| Rate for Payer: Aetna Government |
$12.06
|
| Rate for Payer: Brighton Health Commercial |
$63.75
|
| 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 |
$42.50
|
| Rate for Payer: Group Health Inc Medicare |
$29.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.50
|
|
|
EXTERNAL FIXATION
|
Facility
|
IP
|
$17,690.84
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
40029802
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
EXTERNAL FIXATION
|
Facility
|
OP
|
$17,690.84
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
40029802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,268.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,268.13
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,845.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation
|
Facility
|
OP
|
$4,065.00
|
|
|
Service Code
|
CPT 66982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| 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: Affinity Essential Plan 1&2 |
$1,886.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,886.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,886.42
|
| 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 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 Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Humana Medicare |
$2,748.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
|
|
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 |
$1,468.00 |
| 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: Affinity Essential Plan 1&2 |
$1,886.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,886.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,886.42
|
| 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 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 Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Humana Medicare |
$2,748.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
$40,582.11
|
|
|
Service Code
|
MSDRG 038
|
| Min. Negotiated Rate |
$13,719.10 |
| Max. Negotiated Rate |
$40,582.11 |
| 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: Humana Medicare |
$40,582.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,514.26
|
| Rate for Payer: United Healthcare Commercial |
$31,817.21
|
| Rate for Payer: United Healthcare 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
|
$74,440.55
|
|
|
Service Code
|
MSDRG 037
|
| Min. Negotiated Rate |
$25,174.44 |
| Max. Negotiated Rate |
$74,440.55 |
| 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: Humana Medicare |
$74,440.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54,138.58
|
| Rate for Payer: United Healthcare Commercial |
$67,130.56
|
| Rate for Payer: United Healthcare 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
|
$31,831.96
|
|
|
Service Code
|
MSDRG 039
|
| Min. Negotiated Rate |
$9,784.08 |
| Max. Negotiated Rate |
$31,831.96 |
| 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: Humana Medicare |
$31,831.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,150.52
|
| Rate for Payer: United Healthcare Commercial |
$22,691.07
|
| Rate for Payer: United Healthcare 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: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| 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: Humana Medicare |
$1,038.55
|
| 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: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare 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
|
|
|
EXTRACT ERUPTED TOOTH/EXPOSE ROOT
|
Facility
|
IP
|
$2,953.25
|
|
|
Service Code
|
HCPCS D7140
|
| Hospital Charge Code |
30106627
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
