|
INIT HOSP/BIRTH CTR CARE PER DAY
|
Facility
|
IP
|
$351.13
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
30305381
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$152.87
|
|
|
INITIAL PREVENTATIVE EXAM
|
Facility
|
OP
|
$351.13
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
30105534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.01 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$193.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$152.87
|
| Rate for Payer: Aetna Government |
$152.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$107.01
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$152.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.05
|
| 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 |
$175.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.94
|
| Rate for Payer: Healthfirst QHP |
$152.87
|
| Rate for Payer: Humana Medicare |
$155.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.87
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$122.30
|
| Rate for Payer: Wellcare Medicare |
$145.23
|
|
|
INITIAL PREVENTATIVE EXAM
|
Facility
|
IP
|
$351.13
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
30105534
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$152.87
|
|
|
INITIAL TRMT FIRST DEGREE BURN
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
30105150
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$231.52
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
INITIAL TRMT FIRST DEGREE BURN
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
30105121
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
INITIAL TRMT FIRST DEGREE BURN
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
30105121
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$231.52
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
INITIAL TRMT FIRST DEGREE BURN
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
30105150
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
INITIAT MED ASSIST TX IN ER
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
30300341
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.51
|
| Rate for Payer: Aetna Government |
$42.51
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
INIT/SUB PSYCH CARE M 1ST 30
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
30300342
|
|
Hospital Revenue Code
|
929
|
| Rate for Payer: Cash Price |
$103.08
|
|
|
INIT/SUB PSYCH CARE M 1ST 30
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
30300342
|
|
Hospital Revenue Code
|
929
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$105.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.08
|
| Rate for Payer: Aetna Government |
$103.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$72.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$72.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$72.16
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$103.08
|
| Rate for Payer: EmblemHealth Commercial |
$103.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.74
|
| Rate for Payer: Group Health Inc Commercial |
$103.08
|
| Rate for Payer: Group Health Inc Medicare |
$103.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.62
|
| Rate for Payer: Healthfirst QHP |
$103.08
|
| Rate for Payer: Humana Medicare |
$105.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.08
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.46
|
| Rate for Payer: Wellcare Medicare |
$97.93
|
|
|
INJ, BORTEZOMIB 3.5MG VIAL
|
Facility
|
IP
|
$56.85
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
41657113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$28.42 |
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.42
|
|
|
INJ, BORTEZOMIB 3.5MG VIAL
|
Facility
|
OP
|
$56.85
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
41657113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$34.11
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Commercial |
$9.01
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
INJ, BORTEZOMIB 3.5MG VIAL
|
Facility
|
IP
|
$56.85
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
41647113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$28.42 |
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.42
|
|
|
INJ, BORTEZOMIB 3.5MG VIAL
|
Facility
|
OP
|
$56.85
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
41647113
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$34.11
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Commercial |
$9.01
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 20527
|
| Hospital Charge Code |
30307889
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
INJ DUPUYTREN CORD W/ENZYME
|
Facility
|
IP
|
$792.83
|
|
|
Service Code
|
HCPCS 20527
|
| Hospital Charge Code |
30307889
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
INJECTABLE BULKING AGENT
|
Facility
|
IP
|
$12,500.00
|
|
|
Service Code
|
HCPCS L8605
|
| Hospital Charge Code |
30305432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,250.00 |
| Max. Negotiated Rate |
$6,250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,250.00
|
|
|
INJECTABLE BULKING AGENT
|
Facility
|
OP
|
$12,500.00
|
|
|
Service Code
|
HCPCS L8605
|
| Hospital Charge Code |
30305432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$367.26 |
| Max. Negotiated Rate |
$13,125.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,875.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$367.26
|
| Rate for Payer: Aetna Government |
$367.26
|
| Rate for Payer: Brighton Health Commercial |
$7,500.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,187.50
|
| Rate for Payer: EmblemHealth Commercial |
$6,250.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,125.00
|
| Rate for Payer: Group Health Inc Commercial |
$6,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,125.00
|
|
|
INJECTATE SYSTEM CLOSED ROOM TEMP
|
Facility
|
OP
|
$2.80
|
|
| Hospital Charge Code |
64902243
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.40
|
| Rate for Payer: Aetna Government |
$1.40
|
| Rate for Payer: Brighton Health Commercial |
$2.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.40
|
|
|
INJECT. FOR NERVE BLOCK
|
Facility
|
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
30103238
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$559.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$559.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$559.80
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$799.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| 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 |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: Humana Medicare |
$815.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
INJECT. FOR NERVE BLOCK
|
Facility
|
IP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
30103238
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$799.72
|
|
|
INJECT FOR SPINE DISK XRAY LUMBAR
|
Facility
|
OP
|
$1,088.98
|
|
|
Service Code
|
HCPCS 62290
|
| Hospital Charge Code |
40009841
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.95 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.95
|
| Rate for Payer: Aetna Government |
$197.95
|
| Rate for Payer: Brighton Health Commercial |
$816.74
|
| 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: Group Health Inc Commercial |
$544.49
|
| Rate for Payer: Group Health Inc Medicare |
$381.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$544.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$544.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
INJECTION APPLICATION KIT
|
Facility
|
OP
|
$3,260.00
|
|
| Hospital Charge Code |
40201235
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,141.00 |
| Max. Negotiated Rate |
$2,608.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,793.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,630.00
|
| Rate for Payer: Aetna Government |
$1,630.00
|
| Rate for Payer: Brighton Health Commercial |
$2,445.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,608.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,216.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,630.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,141.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,630.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,630.00
|
|
|
INJECTION EYE DRUG
|
Facility
|
IP
|
$937.70
|
|
|
Service Code
|
HCPCS 67028
|
| Hospital Charge Code |
30300157
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$391.64
|
|
|
INJECTION EYE DRUG
|
Facility
|
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 67028
|
| Hospital Charge Code |
30300157
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$274.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$274.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$274.15
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| 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 |
$391.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$332.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$348.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$348.56
|
| 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 |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Humana Medicare |
$399.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
