|
INTMD WND REPAIR N-HG/GENIT
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 12044
|
| Hospital Charge Code |
30305076
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
INTMD WND REPAIR S/TR/EXT
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
30305073
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
INTMD WND REPAIR S/TR/EXT
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
30305073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
INTMD WND REPAIR S/TR/EXT
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
30103259
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
INTMD WND REPAIR S/TR/EXT
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 12034
|
| Hospital Charge Code |
30103259
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$461.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Facility
|
OP
|
$297.50
|
|
|
Service Code
|
HCPCS 51797 TC
|
| Hospital Charge Code |
30302042
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.42
|
| Rate for Payer: Aetna Government |
$87.42
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.75
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
INTRACAV RAD SRCE APPL,COMP
|
Facility
|
OP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77763 TC
|
| Hospital Charge Code |
66542957
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$580.39 |
| Max. Negotiated Rate |
$1,233.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,233.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.13
|
| Rate for Payer: Aetna Government |
$829.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$580.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$580.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$580.39
|
| Rate for Payer: Brighton Health Commercial |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Cash Price |
$829.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$710.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$829.13
|
| Rate for Payer: EmblemHealth Commercial |
$580.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$704.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$704.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$737.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$737.93
|
| Rate for Payer: Group Health Inc Commercial |
$746.22
|
| Rate for Payer: Group Health Inc Medicare |
$746.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,121.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$746.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$829.13
|
| Rate for Payer: Healthfirst QHP |
$829.13
|
| Rate for Payer: Humana Medicare |
$845.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$829.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$663.30
|
| Rate for Payer: Wellcare Medicare |
$787.67
|
|
|
INTRACAV RAD SRCE APPL,COMP
|
Facility
|
IP
|
$2,242.85
|
|
|
Service Code
|
HCPCS 77763 TC
|
| Hospital Charge Code |
66542957
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$829.13
|
|
|
INTRACAV RAD SRCE APPL,INTER
|
Facility
|
IP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77762 TC
|
| Hospital Charge Code |
66542956
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$680.74
|
|
|
INTRACAV RAD SRCE APPL,INTER
|
Facility
|
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77762 TC
|
| Hospital Charge Code |
66542956
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$476.52 |
| Max. Negotiated Rate |
$897.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$680.74
|
| Rate for Payer: Aetna Government |
$680.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$476.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$476.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$476.52
|
| Rate for Payer: Brighton Health Commercial |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$680.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$710.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$680.74
|
| Rate for Payer: EmblemHealth Commercial |
$476.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$578.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$578.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$605.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$680.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$605.86
|
| Rate for Payer: Group Health Inc Commercial |
$612.67
|
| Rate for Payer: Group Health Inc Medicare |
$612.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$612.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.74
|
| Rate for Payer: Healthfirst QHP |
$680.74
|
| Rate for Payer: Humana Medicare |
$694.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$680.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$544.59
|
| Rate for Payer: Wellcare Medicare |
$646.70
|
|
|
INTRACAV RAD SRCE APPL,SIM
|
Facility
|
OP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77761 TC
|
| Hospital Charge Code |
66542955
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$476.52 |
| Max. Negotiated Rate |
$897.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$897.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$680.74
|
| Rate for Payer: Aetna Government |
$680.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$476.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$476.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$476.52
|
| Rate for Payer: Brighton Health Commercial |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Cash Price |
$680.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$680.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$710.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$601.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$680.74
|
| Rate for Payer: EmblemHealth Commercial |
$476.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$578.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$578.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$605.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$680.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$605.86
|
| Rate for Payer: Group Health Inc Commercial |
$612.67
|
| Rate for Payer: Group Health Inc Medicare |
$612.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$680.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$612.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$680.74
|
| Rate for Payer: Healthfirst QHP |
$680.74
|
| Rate for Payer: Humana Medicare |
$694.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$680.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$680.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$680.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$544.59
|
| Rate for Payer: Wellcare Medicare |
$646.70
|
|
|
INTRACAV RAD SRCE APPL,SIM
|
Facility
|
IP
|
$1,631.98
|
|
|
Service Code
|
HCPCS 77761 TC
|
| Hospital Charge Code |
66542955
|
|
Hospital Revenue Code
|
342
|
| Rate for Payer: Cash Price |
$680.74
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS
|
Facility
|
IP
|
$29,456.16
|
|
|
Service Code
|
MSDRG 065
|
| Min. Negotiated Rate |
$8,715.63 |
| Max. Negotiated Rate |
$29,456.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,986.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,422.66
|
| Rate for Payer: Aetna Government |
$21,422.66
|
| Rate for Payer: Brighton Health Commercial |
$14,737.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,851.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,552.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,484.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,351.53
|
| Rate for Payer: EmblemHealth Commercial |
$8,715.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,422.66
|
| Rate for Payer: Group Health Inc Commercial |
$21,422.66
|
| Rate for Payer: Group Health Inc Medicare |
$21,422.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,422.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,961.54
|
| Rate for Payer: Humana Medicare |
$29,456.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,422.66
|
| Rate for Payer: United Healthcare Commercial |
$20,213.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,422.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,422.66
|
| Rate for Payer: Wellcare Medicare |
$20,351.53
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC
|
Facility
|
IP
|
$48,268.29
|
|
|
Service Code
|
MSDRG 064
|
| Min. Negotiated Rate |
$16,323.46 |
| Max. Negotiated Rate |
$48,268.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,534.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35,104.21
|
| Rate for Payer: Aetna Government |
$35,104.21
|
| Rate for Payer: Brighton Health Commercial |
$29,043.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,806.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,589.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,544.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,349.00
|
| Rate for Payer: EmblemHealth Commercial |
$17,175.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$35,104.21
|
| Rate for Payer: Group Health Inc Commercial |
$35,104.21
|
| Rate for Payer: Group Health Inc Medicare |
$35,104.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35,104.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,323.46
|
| Rate for Payer: Humana Medicare |
$48,268.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35,104.21
|
| Rate for Payer: United Healthcare Commercial |
$39,833.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,104.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35,104.21
|
| Rate for Payer: Wellcare Medicare |
$33,349.00
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$23,184.80
|
|
|
Service Code
|
MSDRG 066
|
| Min. Negotiated Rate |
$5,895.31 |
| Max. Negotiated Rate |
$23,184.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,137.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,861.67
|
| Rate for Payer: Aetna Government |
$16,861.67
|
| Rate for Payer: Brighton Health Commercial |
$9,968.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,198.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,872.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,797.65
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,018.59
|
| Rate for Payer: EmblemHealth Commercial |
$5,895.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,861.67
|
| Rate for Payer: Group Health Inc Commercial |
$16,861.67
|
| Rate for Payer: Group Health Inc Medicare |
$16,861.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,861.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,840.68
|
| Rate for Payer: Humana Medicare |
$23,184.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,861.67
|
| Rate for Payer: United Healthcare Commercial |
$13,672.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,861.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,861.67
|
| Rate for Payer: Wellcare Medicare |
$16,018.59
|
|
|
INTRACRANIAL LIMITED STUDY
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93888 TC
|
| Hospital Charge Code |
41301520
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
INTRACRANIAL LIMITED STUDY
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93888 TC
|
| Hospital Charge Code |
41301520
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$254.59
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$127.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC
|
Facility
|
IP
|
$127,177.88
|
|
|
Service Code
|
MSDRG 021
|
| Min. Negotiated Rate |
$43,009.24 |
| Max. Negotiated Rate |
$127,177.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90,554.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$92,493.00
|
| Rate for Payer: Aetna Government |
$92,493.00
|
| Rate for Payer: Brighton Health Commercial |
$89,050.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$94,342.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106,055.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87,521.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$87,868.35
|
| Rate for Payer: EmblemHealth Commercial |
$52,662.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$92,493.00
|
| Rate for Payer: Group Health Inc Commercial |
$92,493.00
|
| Rate for Payer: Group Health Inc Medicare |
$92,493.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92,493.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43,009.24
|
| Rate for Payer: Humana Medicare |
$127,177.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92,493.00
|
| Rate for Payer: United Healthcare Commercial |
$122,134.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92,493.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92,493.00
|
| Rate for Payer: Wellcare Medicare |
$87,868.35
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$171,243.20
|
|
|
Service Code
|
MSDRG 020
|
| Min. Negotiated Rate |
$57,911.34 |
| Max. Negotiated Rate |
$171,243.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124,630.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$124,540.51
|
| Rate for Payer: Aetna Government |
$124,540.51
|
| Rate for Payer: Brighton Health Commercial |
$122,559.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127,031.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$145,964.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120,456.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$118,313.48
|
| Rate for Payer: EmblemHealth Commercial |
$72,479.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$124,540.51
|
| Rate for Payer: Group Health Inc Commercial |
$124,540.51
|
| Rate for Payer: Group Health Inc Medicare |
$124,540.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124,540.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57,911.34
|
| Rate for Payer: Humana Medicare |
$171,243.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124,540.51
|
| Rate for Payer: United Healthcare Commercial |
$168,092.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124,540.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124,540.51
|
| Rate for Payer: Wellcare Medicare |
$118,313.48
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$84,872.47
|
|
|
Service Code
|
MSDRG 022
|
| Min. Negotiated Rate |
$28,702.32 |
| Max. Negotiated Rate |
$84,872.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51,263.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61,725.43
|
| Rate for Payer: Aetna Government |
$61,725.43
|
| Rate for Payer: Brighton Health Commercial |
$50,412.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62,959.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67,741.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55,902.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$58,639.16
|
| Rate for Payer: EmblemHealth Commercial |
$29,812.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$61,725.43
|
| Rate for Payer: Group Health Inc Commercial |
$61,725.43
|
| Rate for Payer: Group Health Inc Medicare |
$61,725.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61,725.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28,702.32
|
| Rate for Payer: Humana Medicare |
$84,872.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61,725.43
|
| Rate for Payer: United Healthcare Commercial |
$78,010.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61,725.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61,725.43
|
| Rate for Payer: Wellcare Medicare |
$58,639.16
|
|
|
INTRADERMAL RABIES VACCINE
|
Facility
|
IP
|
$568.83
|
|
|
Service Code
|
HCPCS 90676
|
| Hospital Charge Code |
30103322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$284.42 |
| Max. Negotiated Rate |
$284.42 |
| Rate for Payer: Cash Price |
$279.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.42
|
|
|
INTRADERMAL RABIES VACCINE
|
Facility
|
OP
|
$568.83
|
|
|
Service Code
|
HCPCS 90676
|
| Hospital Charge Code |
30103322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.40 |
| Max. Negotiated Rate |
$369.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$312.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$279.15
|
| Rate for Payer: Aetna Government |
$279.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$195.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$195.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$195.40
|
| Rate for Payer: Brighton Health Commercial |
$341.30
|
| Rate for Payer: Cash Price |
$279.15
|
| Rate for Payer: Cash Price |
$279.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$279.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$284.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$327.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$279.15
|
| Rate for Payer: EmblemHealth Commercial |
$279.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$293.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$279.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$293.11
|
| Rate for Payer: Group Health Inc Commercial |
$279.15
|
| Rate for Payer: Group Health Inc Medicare |
$279.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$237.28
|
| Rate for Payer: Healthfirst QHP |
$279.15
|
| Rate for Payer: Humana Medicare |
$284.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$279.15
|
| Rate for Payer: United Healthcare Commercial |
$255.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$369.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$223.32
|
| Rate for Payer: Wellcare Medicare |
$265.19
|
|
|
INTRAMEDULLARY BONE PLUG/MED 16MM
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
|
|
INTRAMEDULLARY BONE PLUG/MED 16MM
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$163.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.40
|
| Rate for Payer: EmblemHealth Commercial |
$136.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.60
|
| Rate for Payer: Group Health Inc Commercial |
$136.00
|
| Rate for Payer: Group Health Inc Medicare |
$95.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.80
|
|
|
INTRANASAL BIOPSY
|
Facility
|
IP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 30100
|
| Hospital Charge Code |
30304090
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,763.60
|
|
