|
INJECTION FOR NERVE BLOCK
|
Facility
|
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
30300108
|
|
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 |
$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 |
$233.00
|
| Rate for Payer: Cash Price |
$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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| 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 |
$222.00
|
| 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
|
|
|
INJECTION FOR NERVE BLOCK
|
Facility
|
IP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
30300108
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$799.72
|
|
|
INJECTION FOR NERVE BLOCK
|
Facility
|
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
30301080
|
|
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 |
$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 |
$233.00
|
| Rate for Payer: Cash Price |
$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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| 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 |
$222.00
|
| 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
|
|
|
INJECTION FOR NERVE BLOCK
|
Facility
|
IP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
30301080
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$799.72
|
|
|
INJECTION GOLD PROBE
|
Facility
|
OP
|
$670.00
|
|
| Hospital Charge Code |
40200284
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$368.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$335.00
|
| Rate for Payer: Aetna Government |
$335.00
|
| Rate for Payer: Brighton Health Commercial |
$502.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$536.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$455.60
|
| Rate for Payer: Group Health Inc Commercial |
$335.00
|
| Rate for Payer: Group Health Inc Medicare |
$234.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$335.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$335.00
|
|
|
INJECTION INTO DISK LESION
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 62292
|
| Hospital Charge Code |
40004071
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
INJECTION INTO DISK LESION
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 62292
|
| Hospital Charge Code |
40004071
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,905.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$3,905.61
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
| Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
INJECTION IV
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
30301123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.51 |
| Max. Negotiated Rate |
$306.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$173.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$173.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$173.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| 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 |
$247.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| 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 |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Humana Medicare |
$252.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
INJECTION IV
|
Facility
|
IP
|
$556.50
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
30301123
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$247.87
|
|
|
INJECTION OF ANTIBIOTIC
|
Facility
|
IP
|
$183.15
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
30301124
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$81.46
|
|
|
INJECTION OF ANTIBIOTIC
|
Facility
|
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
30301124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.36
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| 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 |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| 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 |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Healthfirst Essential Plan |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$13.36
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$13.36
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$30.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$14.70
|
| Rate for Payer: United Healthcare Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
INJECTION OF SINUS TRACT
|
Facility
|
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 20500
|
| Hospital Charge Code |
30306434
|
|
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 |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,234.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,234.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,234.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: 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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.42
|
| 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: Humana Medicare |
$1,798.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,763.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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
|
|
|
INJECTION OF SINUS TRACT
|
Facility
|
IP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 20500
|
| Hospital Charge Code |
30306434
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,763.60
|
|
|
Injection of sinus tract; diagnostic (sinogram)
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 20501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.95
|
| Rate for Payer: Aetna Government |
$37.95
|
| 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: United Healthcare Commercial |
$1,113.00
|
|
|
Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (List separately in addition to code for primary procedure)
|
Facility
|
OP
|
$6,937.00
|
|
|
Service Code
|
CPT 93567
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.82
|
| Rate for Payer: Aetna Government |
$48.82
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,959.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,215.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 50431
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$789.96
|
| Rate for Payer: Aetna Government |
$789.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$552.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$552.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$552.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$789.96
|
| 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 |
$789.96
|
| Rate for Payer: EmblemHealth Commercial |
$789.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$671.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$703.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$789.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$703.06
|
| Rate for Payer: Group Health Inc Commercial |
$789.96
|
| Rate for Payer: Group Health Inc Medicare |
$789.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$789.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$671.47
|
| Rate for Payer: Healthfirst QHP |
$789.96
|
| Rate for Payer: Humana Medicare |
$805.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$789.96
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$789.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$789.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$631.97
|
| Rate for Payer: Wellcare Medicare |
$750.46
|
|
|
Injection procedure for hip arthrography; without anesthesia
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 27093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.25
|
| Rate for Payer: Aetna Government |
$70.25
|
| 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: United Healthcare Commercial |
$1,113.00
|
|
|
Injection procedure; radioactive tracer for identification of sentinel node
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 38792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$333.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$476.96
|
| Rate for Payer: Aetna Government |
$476.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$333.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$333.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$333.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.96
|
| 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 |
$476.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$405.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.49
|
| Rate for Payer: Group Health Inc Commercial |
$476.96
|
| Rate for Payer: Group Health Inc Medicare |
$476.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$405.42
|
| Rate for Payer: Healthfirst QHP |
$476.96
|
| Rate for Payer: Humana Medicare |
$486.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.96
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$381.57
|
| Rate for Payer: Wellcare Medicare |
$453.11
|
|
|
INJECTION, RAMUCIRUMAB 5MG
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
41645761
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
|
|
INJECTION, RAMUCIRUMAB 5MG
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
41645761
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$73.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.24
|
| Rate for Payer: Aetna Government |
$70.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.17
|
| Rate for Payer: Brighton Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.24
|
| Rate for Payer: EmblemHealth Commercial |
$70.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.76
|
| Rate for Payer: Group Health Inc Commercial |
$70.24
|
| Rate for Payer: Group Health Inc Medicare |
$70.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.71
|
| Rate for Payer: Healthfirst QHP |
$70.24
|
| Rate for Payer: Humana Medicare |
$71.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.83
|
| Rate for Payer: SOMOS Essential |
$73.83
|
| Rate for Payer: United Healthcare Commercial |
$66.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.20
|
| Rate for Payer: Wellcare Medicare |
$66.73
|
|
|
INJECTION, RAMUCIRUMAB, 5MG
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
41645759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
|
|
INJECTION, RAMUCIRUMAB, 5MG
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
41645759
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$73.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.24
|
| Rate for Payer: Aetna Government |
$70.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.17
|
| Rate for Payer: Brighton Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Cash Price |
$70.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.24
|
| Rate for Payer: EmblemHealth Commercial |
$70.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.76
|
| Rate for Payer: Group Health Inc Commercial |
$70.24
|
| Rate for Payer: Group Health Inc Medicare |
$70.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.71
|
| Rate for Payer: Healthfirst QHP |
$70.24
|
| Rate for Payer: Humana Medicare |
$71.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.83
|
| Rate for Payer: SOMOS Essential |
$73.83
|
| Rate for Payer: United Healthcare Commercial |
$66.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.20
|
| Rate for Payer: Wellcare Medicare |
$66.73
|
|
|
Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, each additional level (List separately in addition to code for primary procedure)
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 64421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$737.84 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$737.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$737.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$737.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: EmblemHealth Commercial |
$1,054.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| Rate for Payer: Group Health Inc Commercial |
$1,054.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,054.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: Humana Medicare |
$1,075.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
INJECTION SC/IM
|
Facility
|
IP
|
$183.15
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
30301120
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$81.46
|
|
|
INJECTION SC/IM
|
Facility
|
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
30301120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.36
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| 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 |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| 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 |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Healthfirst Essential Plan |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$13.36
|
| Rate for Payer: Humana Medicare |
$83.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$13.36
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$30.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$14.70
|
| Rate for Payer: United Healthcare Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
