|
FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN [32215]
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
55150023010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.43
|
| Rate for Payer: Aetna Government |
$1.43
|
| Rate for Payer: Brighton Health Commercial |
$54.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.96
|
| Rate for Payer: Group Health Inc Commercial |
$36.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.80
|
|
|
FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN [108027]
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
55150023110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$174.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.43
|
| Rate for Payer: Aetna Government |
$1.43
|
| Rate for Payer: Brighton Health Commercial |
$163.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$174.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$148.16
|
| Rate for Payer: Group Health Inc Commercial |
$108.94
|
| Rate for Payer: Group Health Inc Medicare |
$76.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.62
|
|
|
FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN [108027]
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
55150023100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$174.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.43
|
| Rate for Payer: Aetna Government |
$1.43
|
| Rate for Payer: Brighton Health Commercial |
$163.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$174.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$148.16
|
| Rate for Payer: Group Health Inc Commercial |
$108.94
|
| Rate for Payer: Group Health Inc Medicare |
$76.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.62
|
|
|
FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN [108027]
|
Facility
|
OP
|
$321.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
55111067910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$257.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.43
|
| Rate for Payer: Aetna Government |
$1.43
|
| Rate for Payer: Brighton Health Commercial |
$241.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$257.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.64
|
| Rate for Payer: Group Health Inc Commercial |
$160.76
|
| Rate for Payer: Group Health Inc Medicare |
$112.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.99
|
|
|
FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN [108028]
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
55150023210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.43
|
| Rate for Payer: Aetna Government |
$1.43
|
| Rate for Payer: Brighton Health Commercial |
$108.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.50
|
| Rate for Payer: Group Health Inc Medicare |
$50.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.25
|
|
|
FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN [108028]
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
55150023200
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.43
|
| Rate for Payer: Aetna Government |
$1.43
|
| Rate for Payer: Brighton Health Commercial |
$108.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.50
|
| Rate for Payer: Group Health Inc Medicare |
$50.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$94.25
|
|
|
FOOD ALLERGY PROFILE
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40728348
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
FOOD ALLERGY PROFILE
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40728348
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$5.22
|
|
|
FOOT ARCH 180MM
|
Facility
|
OP
|
$3,198.52
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.48 |
| Max. Negotiated Rate |
$3,358.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,759.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,599.26
|
| Rate for Payer: Aetna Government |
$1,599.26
|
| Rate for Payer: Brighton Health Commercial |
$1,919.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,599.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,839.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,599.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,358.45
|
| Rate for Payer: Group Health Inc Commercial |
$1,599.26
|
| Rate for Payer: Group Health Inc Medicare |
$1,119.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,599.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,599.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,079.04
|
|
|
FOOT ARCH 180MM
|
Facility
|
IP
|
$3,198.52
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,599.26 |
| Max. Negotiated Rate |
$1,599.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,599.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,599.26
|
|
|
FOOT CORRXIT AFO W/AMB ATTACH AVG
|
Facility
|
OP
|
$155.25
|
|
| Hospital Charge Code |
64902867
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.62
|
| Rate for Payer: Aetna Government |
$77.62
|
| Rate for Payer: Brighton Health Commercial |
$116.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.57
|
| Rate for Payer: Group Health Inc Commercial |
$77.62
|
| Rate for Payer: Group Health Inc Medicare |
$54.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.62
|
|
|
FOOT OR TOE SURGERY
|
Facility
|
IP
|
$634.45
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
30301512
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$272.71
|
|
|
FOOT OR TOE SURGERY
|
Facility
|
OP
|
$634.45
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
30301512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$190.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$190.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$190.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$190.90
|
| Rate for Payer: Brighton Health Commercial |
$475.84
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: EmblemHealth Commercial |
$272.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| Rate for Payer: Group Health Inc Commercial |
$272.71
|
| Rate for Payer: Group Health Inc Medicare |
$272.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$317.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.80
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: Humana Medicare |
$278.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$43,007.54
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$14,544.37 |
| Max. Negotiated Rate |
$43,007.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25,466.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31,278.21
|
| Rate for Payer: Aetna Government |
$31,278.21
|
| Rate for Payer: Brighton Health Commercial |
$25,042.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,903.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,825.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,613.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,714.30
|
| Rate for Payer: EmblemHealth Commercial |
$14,809.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$31,278.21
|
| Rate for Payer: Group Health Inc Commercial |
$31,278.21
|
| Rate for Payer: Group Health Inc Medicare |
$31,278.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31,278.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,544.37
|
| Rate for Payer: Humana Medicare |
$43,007.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31,278.21
|
| Rate for Payer: United Healthcare Commercial |
$34,346.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,278.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31,278.21
|
| Rate for Payer: Wellcare Medicare |
$29,714.30
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$61,213.32
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$20,701.23 |
| Max. Negotiated Rate |
$61,213.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39,544.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44,518.78
|
| Rate for Payer: Aetna Government |
$44,518.78
|
| Rate for Payer: Brighton Health Commercial |
$38,887.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45,409.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46,313.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38,220.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$42,292.84
|
| Rate for Payer: EmblemHealth Commercial |
$22,997.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$44,518.78
|
| Rate for Payer: Group Health Inc Commercial |
$44,518.78
|
| Rate for Payer: Group Health Inc Medicare |
$44,518.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44,518.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20,701.23
|
| Rate for Payer: Humana Medicare |
$61,213.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44,518.78
|
| Rate for Payer: United Healthcare Commercial |
$53,334.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44,518.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44,518.78
|
| Rate for Payer: Wellcare Medicare |
$42,292.84
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$42,599.48
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$14,406.37 |
| Max. Negotiated Rate |
$42,599.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25,150.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,981.44
|
| Rate for Payer: Aetna Government |
$30,981.44
|
| Rate for Payer: Brighton Health Commercial |
$24,732.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,601.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,455.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,308.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,432.37
|
| Rate for Payer: EmblemHealth Commercial |
$14,626.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,981.44
|
| Rate for Payer: Group Health Inc Commercial |
$30,981.44
|
| Rate for Payer: Group Health Inc Medicare |
$30,981.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,981.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,406.37
|
| Rate for Payer: Humana Medicare |
$42,599.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,981.44
|
| Rate for Payer: United Healthcare Commercial |
$33,921.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,981.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,981.44
|
| Rate for Payer: Wellcare Medicare |
$29,432.37
|
|
|
FORCEP BIOP RAD JAW3 2.2MMX240CM
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
40209797
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.00
|
| Rate for Payer: Aetna Government |
$150.00
|
| Rate for Payer: Brighton Health Commercial |
$225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: Group Health Inc Commercial |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
|
|
FORCEP BIOPSY BX RAD JAW4 RJRLC
|
Facility
|
OP
|
$171.17
|
|
| Hospital Charge Code |
64904684
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.91 |
| Max. Negotiated Rate |
$136.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.58
|
| Rate for Payer: Aetna Government |
$85.58
|
| Rate for Payer: Brighton Health Commercial |
$128.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.40
|
| Rate for Payer: Group Health Inc Commercial |
$85.58
|
| Rate for Payer: Group Health Inc Medicare |
$59.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.58
|
|
|
FORCEP BIOPSY DISP RADIAL JAW
|
Facility
|
OP
|
$178.38
|
|
| Hospital Charge Code |
64903095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.43 |
| Max. Negotiated Rate |
$142.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$98.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$89.19
|
| Rate for Payer: Aetna Government |
$89.19
|
| Rate for Payer: Brighton Health Commercial |
$133.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$142.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.30
|
| Rate for Payer: Group Health Inc Commercial |
$89.19
|
| Rate for Payer: Group Health Inc Medicare |
$62.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.19
|
|
|
FORCEP BIOPSY DISP RADIAL JAW
|
Facility
|
OP
|
$120.00
|
|
| Hospital Charge Code |
40200877
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60.00
|
| Rate for Payer: Aetna Government |
$60.00
|
| Rate for Payer: Brighton Health Commercial |
$90.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.60
|
| Rate for Payer: Group Health Inc Commercial |
$60.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.00
|
|
|
FORCEP BIOPSY RAD JAW 3 160 CM
|
Facility
|
OP
|
$476.00
|
|
| Hospital Charge Code |
40200878
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$261.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$238.00
|
| Rate for Payer: Aetna Government |
$238.00
|
| Rate for Payer: Brighton Health Commercial |
$357.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$380.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$323.68
|
| Rate for Payer: Group Health Inc Commercial |
$238.00
|
| Rate for Payer: Group Health Inc Medicare |
$166.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.00
|
|
|
FORCEP BX RAD JAW3 W/NDL2.2MX240
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
40200879
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.00
|
| Rate for Payer: Aetna Government |
$150.00
|
| Rate for Payer: Brighton Health Commercial |
$225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: Group Health Inc Commercial |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
|
|
FORCEP, CUTTING HALO 5MM/33CM
|
Facility
|
OP
|
$1,650.00
|
|
| Hospital Charge Code |
64905697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$907.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$825.00
|
| Rate for Payer: Aetna Government |
$825.00
|
| Rate for Payer: Brighton Health Commercial |
$1,237.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,122.00
|
| Rate for Payer: Group Health Inc Commercial |
$825.00
|
| Rate for Payer: Group Health Inc Medicare |
$577.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$825.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$825.00
|
|
|
FORCEP DRESSING ADSON#30-1186
|
Facility
|
OP
|
$46.40
|
|
| Hospital Charge Code |
40200444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$37.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.20
|
| Rate for Payer: Aetna Government |
$23.20
|
| Rate for Payer: Brighton Health Commercial |
$34.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.55
|
| Rate for Payer: Group Health Inc Commercial |
$23.20
|
| Rate for Payer: Group Health Inc Medicare |
$16.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.20
|
|
|
FORCEP DRESSING LONG PLAIN 10
|
Facility
|
OP
|
$19.90
|
|
| Hospital Charge Code |
40200445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.95
|
| Rate for Payer: Aetna Government |
$9.95
|
| Rate for Payer: Brighton Health Commercial |
$14.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.53
|
| Rate for Payer: Group Health Inc Commercial |
$9.95
|
| Rate for Payer: Group Health Inc Medicare |
$6.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.95
|
|
