|
APLIGRAF PER SQ CM
|
Facility
|
IP
|
$71.73
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
40203091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$35.86 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.86
|
|
|
APLIGRAF PER SQ CM
|
Facility
|
OP
|
$65.18
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
42500164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.81 |
| Max. Negotiated Rate |
$42.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.43
|
| Rate for Payer: Aetna Government |
$30.43
|
| Rate for Payer: Brighton Health Commercial |
$39.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.48
|
| Rate for Payer: Group Health Inc Commercial |
$32.59
|
| Rate for Payer: Group Health Inc Medicare |
$22.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.46
|
| Rate for Payer: SOMOS Essential |
$32.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.37
|
|
|
APNEA MONITORING
|
Facility
|
OP
|
$70.88
|
|
|
Service Code
|
HCPCS E0619
|
| Hospital Charge Code |
40302301
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.81 |
| Max. Negotiated Rate |
$1,191.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,191.50
|
| Rate for Payer: Aetna Government |
$1,191.50
|
| Rate for Payer: Brighton Health Commercial |
$53.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.20
|
| Rate for Payer: Group Health Inc Commercial |
$35.44
|
| Rate for Payer: Group Health Inc Medicare |
$24.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.44
|
|
|
APNEA TEST
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95824 TC
|
| Hospital Charge Code |
40302300
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$433.87 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$1,103.10
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
APNEA TEST
|
Facility
|
IP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95824 TC
|
| Hospital Charge Code |
40302300
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
APOLIPOPROTEIN A-1
|
Facility
|
OP
|
$52.73
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40609720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$39.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.09
|
| Rate for Payer: Aetna Government |
$21.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.76
|
| Rate for Payer: Brighton Health Commercial |
$39.55
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.09
|
| Rate for Payer: EmblemHealth Commercial |
$21.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.77
|
| Rate for Payer: Group Health Inc Commercial |
$21.09
|
| Rate for Payer: Group Health Inc Medicare |
$21.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.09
|
| Rate for Payer: Healthfirst QHP |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare Commercial |
$19.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.87
|
| Rate for Payer: Wellcare Medicare |
$18.98
|
|
|
APOLIPOPROTEIN A-1
|
Facility
|
IP
|
$52.73
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40609720
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$21.09
|
|
|
APOLIPOPROTEIN B
|
Facility
|
IP
|
$52.73
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40609758
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$21.09
|
|
|
APOLIPOPROTEIN B
|
Facility
|
OP
|
$52.73
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40609758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$39.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.09
|
| Rate for Payer: Aetna Government |
$21.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.76
|
| Rate for Payer: Brighton Health Commercial |
$39.55
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.09
|
| Rate for Payer: EmblemHealth Commercial |
$21.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.77
|
| Rate for Payer: Group Health Inc Commercial |
$21.09
|
| Rate for Payer: Group Health Inc Medicare |
$21.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.09
|
| Rate for Payer: Healthfirst QHP |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare Commercial |
$19.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.87
|
| Rate for Payer: Wellcare Medicare |
$18.98
|
|
|
APPENDECTOMY OPEN
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
40019512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$8,923.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,748.99
|
| Rate for Payer: Aetna Government |
$8,748.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,124.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,124.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,124.29
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,748.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$8,748.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,436.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,786.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,748.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,786.60
|
| Rate for Payer: Group Health Inc Commercial |
$8,748.99
|
| Rate for Payer: Group Health Inc Medicare |
$8,748.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,748.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,436.64
|
| Rate for Payer: Healthfirst QHP |
$8,748.99
|
| Rate for Payer: Humana Medicare |
$8,923.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,748.99
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,748.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,748.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,999.19
|
| Rate for Payer: Wellcare Medicare |
$8,311.54
|
|
|
APPENDECTOMY OPEN
|
Facility
|
IP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
40019512
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,748.99
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
|
IP
|
$38,930.87
|
|
|
Service Code
|
MSDRG 398
|
| Min. Negotiated Rate |
$12,976.50 |
| Max. Negotiated Rate |
$38,930.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,313.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,313.36
|
| Rate for Payer: Aetna Government |
$28,313.36
|
| Rate for Payer: Brighton Health Commercial |
$21,942.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,879.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,133.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,566.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,897.69
|
| Rate for Payer: EmblemHealth Commercial |
$12,976.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,313.36
|
| Rate for Payer: Group Health Inc Commercial |
$28,313.36
|
| Rate for Payer: Group Health Inc Medicare |
$28,313.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,313.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,165.71
|
| Rate for Payer: Humana Medicare |
$38,930.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,313.36
|
| Rate for Payer: United Healthcare Commercial |
$30,095.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,313.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,313.36
|
| Rate for Payer: Wellcare Medicare |
$26,897.69
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
|
IP
|
$52,913.18
|
|
|
Service Code
|
MSDRG 397
|
| Min. Negotiated Rate |
$17,894.27 |
| Max. Negotiated Rate |
$52,913.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,126.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,482.31
|
| Rate for Payer: Aetna Government |
$38,482.31
|
| Rate for Payer: Brighton Health Commercial |
$32,575.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,251.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38,796.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,016.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,558.19
|
| Rate for Payer: EmblemHealth Commercial |
$19,264.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,482.31
|
| Rate for Payer: Group Health Inc Commercial |
$38,482.31
|
| Rate for Payer: Group Health Inc Medicare |
$38,482.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,482.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,894.27
|
| Rate for Payer: Humana Medicare |
$52,913.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,482.31
|
| Rate for Payer: United Healthcare Commercial |
$44,678.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,482.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,482.31
|
| Rate for Payer: Wellcare Medicare |
$36,558.19
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,299.98
|
|
|
Service Code
|
MSDRG 399
|
| Min. Negotiated Rate |
$9,544.83 |
| Max. Negotiated Rate |
$31,299.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,412.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,763.62
|
| Rate for Payer: Aetna Government |
$22,763.62
|
| Rate for Payer: Brighton Health Commercial |
$16,139.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,218.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,222.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,862.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,625.44
|
| Rate for Payer: EmblemHealth Commercial |
$9,544.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,763.62
|
| Rate for Payer: Group Health Inc Commercial |
$22,763.62
|
| Rate for Payer: Group Health Inc Medicare |
$22,763.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,763.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,585.08
|
| Rate for Payer: Humana Medicare |
$31,299.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,763.62
|
| Rate for Payer: United Healthcare Commercial |
$22,136.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,763.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,763.62
|
| Rate for Payer: Wellcare Medicare |
$21,625.44
|
|
|
APPLICATION CAST LEG
|
Facility
|
IP
|
$696.08
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
30302025
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$310.57
|
|
|
APPLICATION CAST LEG
|
Facility
|
OP
|
$696.08
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
30302025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.98
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: Humana Medicare |
$316.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$295.04
|
|
|
APPLICATION CAST LEG
|
Facility
|
IP
|
$696.08
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
40082595
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$310.57
|
|
|
APPLICATION CAST LEG
|
Facility
|
OP
|
$696.08
|
|
|
Service Code
|
HCPCS 29345
|
| Hospital Charge Code |
40082595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$217.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$217.40
|
| Rate for Payer: Brighton Health Commercial |
$522.06
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.57
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| Rate for Payer: Group Health Inc Commercial |
$310.57
|
| Rate for Payer: Group Health Inc Medicare |
$310.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.98
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: Humana Medicare |
$316.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$295.04
|
|
|
APPLICATION LOWER LEG SPLINT
|
Facility
|
IP
|
$405.08
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
30100163
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
APPLICATION LOWER LEG SPLINT
|
Facility
|
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
30100163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.55
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$182.22
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| 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 |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Humana Medicare |
$185.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
APPLICATION OF DESENSITIZING MEDI
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS D9910
|
| Hospital Charge Code |
42302365
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.78
|
| Rate for Payer: Aetna Government |
$12.78
|
| Rate for Payer: Brighton Health Commercial |
$51.00
|
| 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 |
$34.00
|
| Rate for Payer: Group Health Inc Medicare |
$23.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.00
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
30301030
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
30301030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
IP
|
$358.63
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
30300103
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
APPLICATION OF FINGER SPLINT
|
Facility
|
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
30300103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
