|
APHERESIS ADSORP/REINFUSE
|
Facility
OP
|
$11,564.85
|
|
|
Service Code
|
HCPCS 36516
|
| Hospital Charge Code |
30103089
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$95.37 |
| Max. Negotiated Rate |
$5,782.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,351.70
|
| Rate for Payer: Aetna Government |
$5,351.70
|
| Rate for Payer: Cash Price |
$5,351.70
|
| Rate for Payer: Cash Price |
$5,351.70
|
| Rate for Payer: Cash Price |
$5,351.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,351.70
|
| 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 |
$5,351.70
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,548.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,763.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,351.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,763.01
|
| Rate for Payer: Group Health Inc Commercial |
$5,351.70
|
| Rate for Payer: Group Health Inc Medicare |
$5,351.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,782.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,351.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,548.94
|
| Rate for Payer: Healthfirst QHP |
$5,351.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,351.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,351.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,281.36
|
| Rate for Payer: Wellcare Medicare |
$5,084.12
|
|
|
APICALLY POSITIONED FLAP
|
Facility
OP
|
$312.50
|
|
|
Service Code
|
HCPCS D4245
|
| Hospital Charge Code |
42303306
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| 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 |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,763.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
APICOECTOMY/PERIRADICULAR SURG-BI
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
HCPCS D3421
|
| Hospital Charge Code |
42300775
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health 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
|
|
|
APICOECTOMY/PERIRADICULAR SURG (E
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
HCPCS D3426
|
| Hospital Charge Code |
42300785
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$89.95
|
| Rate for Payer: Aetna Government |
$89.95
|
| 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 |
$75.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
|
|
APICOECTOMY/PERIRADICULAR SURGERY
|
Facility
OP
|
$400.00
|
|
|
Service Code
|
HCPCS D3410
|
| Hospital Charge Code |
42300765
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health 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
|
|
|
APICOECTOMY/PERIRADICULAR SURG-MO
|
Facility
OP
|
$450.00
|
|
|
Service Code
|
HCPCS D3425
|
| Hospital Charge Code |
42300780
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health 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
|
|
|
APIXABAN 2.5 MG
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
41645909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
APIXABAN 2.5MG
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
41655909
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
APIXABAN 5MG TAB
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
41655911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
APIXABAN 5MG TAB
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
41645911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
APLIGRAF LIVING CELL BASED PROD
|
Facility
IP
|
$597.50
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
64904812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.75 |
| Max. Negotiated Rate |
$298.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$298.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$298.75
|
|
|
APLIGRAF LIVING CELL BASED PROD
|
Facility
OP
|
$597.50
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
64904812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$388.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$328.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.43
|
| Rate for Payer: Aetna Government |
$30.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$298.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$343.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.38
|
| Rate for Payer: Group Health Inc Commercial |
$298.75
|
| Rate for Payer: Group Health Inc Medicare |
$209.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$298.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$298.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.46
|
| Rate for Payer: SOMOS Essential |
$32.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$388.38
|
|
|
APLIGRAF PER SQ CM
|
Facility
OP
|
$65.18
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
42500164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$42.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.43
|
| Rate for Payer: Aetna Government |
$30.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.38
|
| Rate for Payer: Group Health Inc Commercial |
$32.59
|
| Rate for Payer: Group Health Inc Medicare |
$22.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.46
|
| Rate for Payer: SOMOS Essential |
$32.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.37
|
|
|
APLIGRAF PER SQ CM
|
Facility
OP
|
$71.73
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
40203091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$46.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.43
|
| Rate for Payer: Aetna Government |
$30.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.38
|
| Rate for Payer: Group Health Inc Commercial |
$35.86
|
| Rate for Payer: Group Health Inc Medicare |
$25.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.46
|
| Rate for Payer: SOMOS Essential |
$32.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.62
|
|
|
APLIGRAF PER SQ CM
|
Facility
IP
|
$71.73
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
40203091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.86
|
|
|
APLIGRAF PER SQ CM
|
Facility
IP
|
$65.18
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
42500164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$32.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.59
|
|
|
APNEA MONITORING
|
Facility
OP
|
$70.88
|
|
|
Service Code
|
HCPCS E0619
|
| Hospital Charge Code |
40302301
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$1,191.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,191.50
|
| Rate for Payer: Aetna Government |
$1,191.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.20
|
| Rate for Payer: Group Health Inc Commercial |
$35.44
|
| Rate for Payer: Group Health Inc Medicare |
$24.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.44
|
|
|
APNEA TEST
|
Facility
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95824 TC
|
| Hospital Charge Code |
40302300
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$514.78 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$735.40
|
| Rate for Payer: Aetna Government |
$735.40
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Group Health Inc Commercial |
$735.40
|
| Rate for Payer: Group Health Inc Medicare |
$514.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.40
|
|
|
APOLIPOPROTEIN A-1
|
Facility
OP
|
$52.73
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40609720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.09
|
| Rate for Payer: Aetna Government |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.09
|
| Rate for Payer: EmblemHealth Commercial |
$21.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.77
|
| Rate for Payer: Group Health Inc Commercial |
$21.09
|
| Rate for Payer: Group Health Inc Medicare |
$21.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.09
|
| Rate for Payer: Healthfirst QHP |
$21.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.87
|
| Rate for Payer: Wellcare Medicare |
$18.98
|
|
|
APOLIPOPROTEIN B
|
Facility
OP
|
$52.73
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40609758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.09
|
| Rate for Payer: Aetna Government |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.09
|
| Rate for Payer: EmblemHealth Commercial |
$21.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.77
|
| Rate for Payer: Group Health Inc Commercial |
$21.09
|
| Rate for Payer: Group Health Inc Medicare |
$21.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.09
|
| Rate for Payer: Healthfirst QHP |
$21.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.87
|
| Rate for Payer: Wellcare Medicare |
$18.98
|
|
|
APPENDECTOMY OPEN
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
40019512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$744.81 |
| Max. Negotiated Rate |
$8,748.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,748.99
|
| Rate for Payer: Aetna Government |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,748.99
|
| 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 |
$8,748.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$744.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,436.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,786.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,748.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,786.60
|
| Rate for Payer: Group Health Inc Commercial |
$8,748.99
|
| Rate for Payer: Group Health Inc Medicare |
$8,748.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,748.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$827.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,436.64
|
| Rate for Payer: Healthfirst QHP |
$8,748.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,748.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,748.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,999.19
|
| Rate for Payer: Wellcare Medicare |
$8,311.54
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
IP
|
$28,879.63
|
|
|
Service Code
|
MS-DRG 398
|
| Min. Negotiated Rate |
$12,976.50 |
| Max. Negotiated Rate |
$28,879.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,313.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,313.36
|
| Rate for Payer: Aetna Government |
$28,313.36
|
| Rate for Payer: Brighton Health Commercial |
$21,942.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,879.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,133.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,566.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,897.69
|
| Rate for Payer: EmblemHealth Commercial |
$12,976.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,313.36
|
| Rate for Payer: Group Health Inc Commercial |
$28,313.36
|
| Rate for Payer: Group Health Inc Medicare |
$28,313.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,313.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,165.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,313.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,313.36
|
| Rate for Payer: Wellcare Medicare |
$26,897.69
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
IP
|
$39,251.96
|
|
|
Service Code
|
MS-DRG 397
|
| Min. Negotiated Rate |
$17,894.27 |
| Max. Negotiated Rate |
$39,251.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,126.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,482.31
|
| Rate for Payer: Aetna Government |
$38,482.31
|
| Rate for Payer: Brighton Health Commercial |
$32,575.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,251.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38,796.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,016.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,558.19
|
| Rate for Payer: EmblemHealth Commercial |
$19,264.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,482.31
|
| Rate for Payer: Group Health Inc Commercial |
$38,482.31
|
| Rate for Payer: Group Health Inc Medicare |
$38,482.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,482.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,894.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,482.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,482.31
|
| Rate for Payer: Wellcare Medicare |
$36,558.19
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$23,218.89
|
|
|
Service Code
|
MS-DRG 399
|
| Min. Negotiated Rate |
$9,544.83 |
| Max. Negotiated Rate |
$23,218.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,412.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,763.62
|
| Rate for Payer: Aetna Government |
$22,763.62
|
| Rate for Payer: Brighton Health Commercial |
$16,139.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,218.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,222.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,862.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,625.44
|
| Rate for Payer: EmblemHealth Commercial |
$9,544.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,763.62
|
| Rate for Payer: Group Health Inc Commercial |
$22,763.62
|
| Rate for Payer: Group Health Inc Medicare |
$22,763.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,763.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,585.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,763.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,763.62
|
| Rate for Payer: Wellcare Medicare |
$21,625.44
|
|
|
APPLICATION CAST LEG
|
Facility
OP
|
$696.08
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
40082595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$112.14 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| 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 |
$310.57
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| Rate for Payer: Group Health Inc Commercial |
$310.57
|
| Rate for Payer: Group Health Inc Medicare |
$310.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.98
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$295.04
|
|
