|
JIG KNOB
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$211.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$230.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$220.80
|
| Rate for Payer: EmblemHealth Commercial |
$192.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$403.20
|
| Rate for Payer: Group Health Inc Commercial |
$192.00
|
| Rate for Payer: Group Health Inc Medicare |
$134.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$249.60
|
|
|
JIG KNOB 1.5M
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$480.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$460.00
|
| Rate for Payer: EmblemHealth Commercial |
$400.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$840.00
|
| Rate for Payer: Group Health Inc Commercial |
$400.00
|
| Rate for Payer: Group Health Inc Medicare |
$280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.00
|
|
|
JIG KNOB 1.5M
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
|
|
JIG KNOB RETAINER
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$144.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.00
|
| Rate for Payer: EmblemHealth Commercial |
$120.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.00
|
| Rate for Payer: Group Health Inc Commercial |
$120.00
|
| Rate for Payer: Group Health Inc Medicare |
$84.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.00
|
|
|
JIG KNOB RETAINER
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.00
|
|
|
J&J CATH. HAKIM PERITONEAL 85CM
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
40009356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.00
|
| Rate for Payer: Aetna Government |
$114.00
|
| Rate for Payer: Brighton Health Commercial |
$171.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$182.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.04
|
| Rate for Payer: Group Health Inc Commercial |
$114.00
|
| Rate for Payer: Group Health Inc Medicare |
$79.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.00
|
|
|
J&J CATH. HAKIM PERITONEAL 85CM
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
40203372
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.78
|
| Rate for Payer: Aetna Government |
$98.78
|
| Rate for Payer: Brighton Health Commercial |
$171.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$182.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.04
|
| Rate for Payer: Group Health Inc Commercial |
$114.00
|
| Rate for Payer: Group Health Inc Medicare |
$79.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.00
|
|
|
J&J KIT VENTRICULOSTOMY GHAJAR
|
Facility
|
OP
|
$1,117.08
|
|
| Hospital Charge Code |
40009315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.98 |
| Max. Negotiated Rate |
$893.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$614.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$558.54
|
| Rate for Payer: Aetna Government |
$558.54
|
| Rate for Payer: Brighton Health Commercial |
$837.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$893.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$759.61
|
| Rate for Payer: Group Health Inc Commercial |
$558.54
|
| Rate for Payer: Group Health Inc Medicare |
$390.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.54
|
|
|
J&J KIT VENTRICULOSTOMY GHAJAR
|
Facility
|
OP
|
$1,117.08
|
|
| Hospital Charge Code |
40203333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.98 |
| Max. Negotiated Rate |
$893.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$614.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$558.54
|
| Rate for Payer: Aetna Government |
$558.54
|
| Rate for Payer: Brighton Health Commercial |
$837.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$893.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$759.61
|
| Rate for Payer: Group Health Inc Commercial |
$558.54
|
| Rate for Payer: Group Health Inc Medicare |
$390.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.54
|
|
|
J&J PERFORATOR DISPOSABLE
|
Facility
|
OP
|
$223.60
|
|
| Hospital Charge Code |
40009337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$178.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Government |
$111.80
|
| Rate for Payer: Brighton Health Commercial |
$167.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$178.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$152.05
|
| Rate for Payer: Group Health Inc Commercial |
$111.80
|
| Rate for Payer: Group Health Inc Medicare |
$78.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.80
|
|
|
J&J PERFORATOR DISPOSABLE
|
Facility
|
OP
|
$223.60
|
|
| Hospital Charge Code |
40203354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$178.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Government |
$111.80
|
| Rate for Payer: Brighton Health Commercial |
$167.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$178.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$152.05
|
| Rate for Payer: Group Health Inc Commercial |
$111.80
|
| Rate for Payer: Group Health Inc Medicare |
$78.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.80
|
|
|
JJ SCRW SLF DRILL 14MM
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40206093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$555.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$555.00
|
|
|
JJ SCRW SLF DRILL 14MM
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40206093
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$610.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$666.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$555.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$638.25
|
| Rate for Payer: EmblemHealth Commercial |
$555.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,165.50
|
| Rate for Payer: Group Health Inc Commercial |
$555.00
|
| Rate for Payer: Group Health Inc Medicare |
$388.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$555.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$555.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$721.50
|
|
|
JJ UNIPLTE 2 36MM
|
Facility
|
IP
|
$3,270.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40206092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,635.00 |
| Max. Negotiated Rate |
$1,635.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,635.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,635.00
|
|
|
JJ UNIPLTE 2 36MM
|
Facility
|
OP
|
$3,270.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40206092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,433.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,798.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,962.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,635.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,880.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,635.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,433.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,635.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,635.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,635.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,125.50
|
|
|
JKA ANTIGEN TYPE
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
JKA ANTIGEN TYPE
|
Facility
|
IP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701255
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$415.67
|
|
|
JKB ANTIGEN TYPE
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
JKB ANTIGEN TYPE
|
Facility
|
IP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701256
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$415.67
|
|
|
JOHNSON AND JOHNSON VISION
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40207450
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$78.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: EmblemHealth Commercial |
$65.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.50
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|
|
JOHNSON&JOHNSON CATH KIT W/BACT
|
Facility
|
OP
|
$1,240.00
|
|
| Hospital Charge Code |
40205328
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$434.00 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$682.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$620.00
|
| Rate for Payer: Aetna Government |
$620.00
|
| Rate for Payer: Brighton Health Commercial |
$930.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$843.20
|
| Rate for Payer: Group Health Inc Commercial |
$620.00
|
| Rate for Payer: Group Health Inc Medicare |
$434.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$620.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$620.00
|
|
|
JOHNSON & JOHNSON VSION + 22.0D
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40005247
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$341.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$178.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$195.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$260.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$221.00
|
| Rate for Payer: EmblemHealth Commercial |
$162.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$341.25
|
| Rate for Payer: Group Health Inc Commercial |
$162.50
|
| Rate for Payer: Group Health Inc Medicare |
$113.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.25
|
|
|
JOHNSON & JOHNSON VSION + 30.D
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40005248
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$78.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: EmblemHealth Commercial |
$65.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.50
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.50
|
|
|
JOINT RECONSTRUCTION
|
Facility
|
OP
|
$7,250.00
|
|
|
Service Code
|
HCPCS D7858
|
| Hospital Charge Code |
42301980
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$5,437.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,987.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,721.52
|
| Rate for Payer: Aetna Government |
$3,721.52
|
| Rate for Payer: Brighton Health Commercial |
$5,437.50
|
| 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 |
$3,625.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,537.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,625.00
|
|
|
JOINT RESECT TOES W IMPLANT
|
Facility
|
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 28291
|
| Hospital Charge Code |
40029958
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,588.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,588.37
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
