|
NERVE BLOCK SYMPH GANGLION
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 64505
|
| Hospital Charge Code |
30302472
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
NERVE CONNECTOR
|
Facility
|
OP
|
$3,587.50
|
|
| Hospital Charge Code |
64907148
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,255.62 |
| Max. Negotiated Rate |
$2,870.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,973.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,793.75
|
| Rate for Payer: Aetna Government |
$1,793.75
|
| Rate for Payer: Brighton Health Commercial |
$2,690.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,870.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,439.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,793.75
|
| Rate for Payer: Group Health Inc Medicare |
$1,255.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,793.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,793.75
|
|
|
NERVE GUIDE 3.0MMX 3CM
|
Facility
|
IP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40205388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,045.00 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.00
|
|
|
NERVE GUIDE 3.0MMX 3CM
|
Facility
|
OP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40205388
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$2,194.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,149.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$1,254.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,045.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,201.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,045.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,194.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,045.00
|
| Rate for Payer: Group Health Inc Medicare |
$731.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,358.50
|
|
|
NERVE GUIDE 4.0MMX3CM
|
Facility
|
IP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40205389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,045.00 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.00
|
|
|
NERVE GUIDE 4.0MMX3CM
|
Facility
|
OP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40205389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$2,194.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,149.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$1,254.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,045.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,201.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,045.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,194.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,045.00
|
| Rate for Payer: Group Health Inc Medicare |
$731.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,358.50
|
|
|
NERVE GUIDE 6.0MMX3CM
|
Facility
|
OP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40205390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$2,194.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,149.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$1,254.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,045.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,201.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,045.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,194.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,045.00
|
| Rate for Payer: Group Health Inc Medicare |
$731.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,358.50
|
|
|
NERVE GUIDE 6.0MMX3CM
|
Facility
|
IP
|
$2,090.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40205390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,045.00 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,045.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,045.00
|
|
|
NERVE PROTECTOR
|
Facility
|
OP
|
$4,462.50
|
|
| Hospital Charge Code |
64907147
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,561.88 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,454.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,231.25
|
| Rate for Payer: Aetna Government |
$2,231.25
|
| Rate for Payer: Brighton Health Commercial |
$3,346.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,570.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,034.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,231.25
|
| Rate for Payer: Group Health Inc Medicare |
$1,561.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,231.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,231.25
|
|
|
NERVE REPAIR (1)
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64831
|
| Hospital Charge Code |
40021760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,905.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$1,835.00
|
| 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
|
|
|
NERVE REPAIR (1)
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64831
|
| Hospital Charge Code |
40021760
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
NERVE REPAIR EACH ADDITIONAL
|
Facility
|
OP
|
$2,476.50
|
|
|
Service Code
|
HCPCS 64832
|
| Hospital Charge Code |
40023239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$398.12 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$398.12
|
| Rate for Payer: Aetna Government |
$398.12
|
| Rate for Payer: Brighton Health Commercial |
$1,857.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,238.25
|
| Rate for Payer: Group Health Inc Medicare |
$866.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,238.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,238.25
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
NERVE REPAIR MEDIAN MOTOR THENAR
|
Facility
|
IP
|
$16,685.43
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
40004379
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,703.44
|
|
|
NERVE REPAIR MEDIAN MOTOR THENAR
|
Facility
|
OP
|
$16,685.43
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
40004379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$12,514.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,703.44
|
| Rate for Payer: Aetna Government |
$7,703.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,392.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,392.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,392.41
|
| Rate for Payer: Brighton Health Commercial |
$12,514.07
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,703.44
|
| 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 |
$7,703.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,547.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,856.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,703.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,856.06
|
| Rate for Payer: Group Health Inc Commercial |
$7,703.44
|
| Rate for Payer: Group Health Inc Medicare |
$7,703.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,342.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,703.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,547.92
|
| Rate for Payer: Healthfirst QHP |
$7,703.44
|
| Rate for Payer: Humana Medicare |
$7,857.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,703.44
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,703.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,703.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,162.75
|
| Rate for Payer: Wellcare Medicare |
$7,318.27
|
|
|
NERVE REPAIR ULNAR MOTOR
|
Facility
|
IP
|
$16,685.43
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
40009956
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,703.44
|
|
|
NERVE REPAIR ULNAR MOTOR
|
Facility
|
OP
|
$16,685.43
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
40009956
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$12,514.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,703.44
|
| Rate for Payer: Aetna Government |
$7,703.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,392.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,392.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,392.41
|
| Rate for Payer: Brighton Health Commercial |
$12,514.07
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,703.44
|
| 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 |
$7,703.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,547.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,856.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,703.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,856.06
|
| Rate for Payer: Group Health Inc Commercial |
$7,703.44
|
| Rate for Payer: Group Health Inc Medicare |
$7,703.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,342.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,703.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,547.92
|
| Rate for Payer: Healthfirst QHP |
$7,703.44
|
| Rate for Payer: Humana Medicare |
$7,857.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,703.44
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,703.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,703.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,162.75
|
| Rate for Payer: Wellcare Medicare |
$7,318.27
|
|
|
Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve
|
Facility
|
OP
|
$7,857.51
|
|
|
Service Code
|
CPT 64910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,857.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,703.44
|
| Rate for Payer: Aetna Government |
$7,703.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,392.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,392.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,392.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,703.44
|
| 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 |
$7,703.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,547.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,856.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,703.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,856.06
|
| Rate for Payer: Group Health Inc Commercial |
$7,703.44
|
| Rate for Payer: Group Health Inc Medicare |
$7,703.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,703.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,547.92
|
| Rate for Payer: Healthfirst QHP |
$7,703.44
|
| Rate for Payer: Humana Medicare |
$7,857.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,703.44
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,703.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,703.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,162.75
|
| Rate for Payer: Wellcare Medicare |
$7,318.27
|
|
|
NERVE ULNAR TRANSPOSITIONING
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
40063199
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,905.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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
|
|
|
NERVE ULNAR TRANSPOSITIONING
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64718
|
| Hospital Charge Code |
40063199
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
NERVOUS SYSTEM NEOPLASMS WITH MCC
|
Facility
|
IP
|
$38,171.98
|
|
|
Service Code
|
MSDRG 054
|
| Min. Negotiated Rate |
$12,635.30 |
| Max. Negotiated Rate |
$38,171.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,726.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,761.44
|
| Rate for Payer: Aetna Government |
$27,761.44
|
| Rate for Payer: Brighton Health Commercial |
$21,365.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,316.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,445.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,999.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,373.37
|
| Rate for Payer: EmblemHealth Commercial |
$12,635.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,761.44
|
| Rate for Payer: Group Health Inc Commercial |
$27,761.44
|
| Rate for Payer: Group Health Inc Medicare |
$27,761.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,761.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,909.07
|
| Rate for Payer: Humana Medicare |
$38,171.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,761.44
|
| Rate for Payer: United Healthcare Commercial |
$29,303.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,761.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,761.44
|
| Rate for Payer: Wellcare Medicare |
$26,373.37
|
|
|
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC
|
Facility
|
IP
|
$30,539.19
|
|
|
Service Code
|
MSDRG 055
|
| Min. Negotiated Rate |
$9,202.69 |
| Max. Negotiated Rate |
$30,539.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,824.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,210.32
|
| Rate for Payer: Aetna Government |
$22,210.32
|
| Rate for Payer: Brighton Health Commercial |
$15,561.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,654.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,533.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,294.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,099.80
|
| Rate for Payer: EmblemHealth Commercial |
$9,202.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,210.32
|
| Rate for Payer: Group Health Inc Commercial |
$22,210.32
|
| Rate for Payer: Group Health Inc Medicare |
$22,210.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,210.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,327.80
|
| Rate for Payer: Humana Medicare |
$30,539.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,210.32
|
| Rate for Payer: United Healthcare Commercial |
$21,342.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,210.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,210.32
|
| Rate for Payer: Wellcare Medicare |
$21,099.80
|
|
|
NESIRITIDE 1.5 MG INJ
|
Facility
|
OP
|
$99.20
|
|
| Hospital Charge Code |
41642899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$79.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.60
|
| Rate for Payer: Aetna Government |
$49.60
|
| Rate for Payer: Brighton Health Commercial |
$74.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.46
|
| Rate for Payer: Group Health Inc Commercial |
$49.60
|
| Rate for Payer: Group Health Inc Medicare |
$34.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.48
|
|
|
NESIRITIDE 1.5 MG INJ
|
Facility
|
OP
|
$99.20
|
|
| Hospital Charge Code |
41652899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$79.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.60
|
| Rate for Payer: Aetna Government |
$49.60
|
| Rate for Payer: Brighton Health Commercial |
$74.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.46
|
| Rate for Payer: Group Health Inc Commercial |
$49.60
|
| Rate for Payer: Group Health Inc Medicare |
$34.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.48
|
|
|
NET RETRIEVAL RESCUENET
|
Facility
|
OP
|
$171.66
|
|
| Hospital Charge Code |
64906823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.08 |
| Max. Negotiated Rate |
$137.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.83
|
| Rate for Payer: Aetna Government |
$85.83
|
| Rate for Payer: Brighton Health Commercial |
$128.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$137.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.73
|
| Rate for Payer: Group Health Inc Commercial |
$85.83
|
| Rate for Payer: Group Health Inc Medicare |
$60.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.83
|
|
|
NET RETRIEVAL ROTH 2.5MM DISP
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
40205971
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$142.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$89.00
|
| Rate for Payer: Aetna Government |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$133.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$142.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.04
|
| Rate for Payer: Group Health Inc Commercial |
$89.00
|
| Rate for Payer: Group Health Inc Medicare |
$62.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.00
|
|
