ONDANSETRON SOLN 0.8MG 1ML UD
|
Facility
|
OP
|
$0.90
|
|
Hospital Charge Code |
41656555
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.32 |
Max. Negotiated Rate |
$0.72 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
Rate for Payer: Aetna Government |
$0.45
|
Rate for Payer: Brighton Health Commercial |
$0.68
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.72
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
Rate for Payer: Group Health Inc Commercial |
$0.45
|
Rate for Payer: Group Health Inc Medicare |
$0.32
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
ONDANSETRON SOLN 1MG/1.25 ML UD
|
Facility
|
OP
|
$1.12
|
|
Hospital Charge Code |
41656604
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.39 |
Max. Negotiated Rate |
$0.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.56
|
Rate for Payer: Aetna Government |
$0.56
|
Rate for Payer: Brighton Health Commercial |
$0.84
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.76
|
Rate for Payer: Group Health Inc Commercial |
$0.56
|
Rate for Payer: Group Health Inc Medicare |
$0.39
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.73
|
|
ONDANSETRON SOLN 1MG/1.25ML UD
|
Facility
|
OP
|
$1.12
|
|
Hospital Charge Code |
41646604
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.39 |
Max. Negotiated Rate |
$0.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.56
|
Rate for Payer: Aetna Government |
$0.56
|
Rate for Payer: Brighton Health Commercial |
$0.84
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.76
|
Rate for Payer: Group Health Inc Commercial |
$0.56
|
Rate for Payer: Group Health Inc Medicare |
$0.39
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.73
|
|
ONLAY-PORCELAIN.CERAMIC 3+SURF.
|
Facility
|
OP
|
$1,240.00
|
|
Service Code
|
HCPCS D6609
|
Hospital Charge Code |
42303457
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$272.80 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$682.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.80
|
Rate for Payer: Aetna Government |
$272.80
|
Rate for Payer: Brighton Health Commercial |
$930.00
|
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 |
$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
|
|
ON/OFF TRAY
|
Facility
|
OP
|
$17.37
|
|
Hospital Charge Code |
42905265
|
Hospital Revenue Code
|
801
|
Min. Negotiated Rate |
$6.08 |
Max. Negotiated Rate |
$13.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.68
|
Rate for Payer: Aetna Government |
$8.68
|
Rate for Payer: Brighton Health Commercial |
$13.03
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.90
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.81
|
Rate for Payer: Group Health Inc Commercial |
$8.68
|
Rate for Payer: Group Health Inc Medicare |
$6.08
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$8.68
|
|
ONYX FRONTIER CORONARY STENT
|
Facility
|
OP
|
$2,625.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66521446
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$265.52 |
Max. Negotiated Rate |
$2,756.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,443.75
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
Rate for Payer: Aetna Government |
$265.52
|
Rate for Payer: Brighton Health Commercial |
$1,575.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,312.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,509.38
|
Rate for Payer: EmblemHealth Commercial |
$1,312.50
|
Rate for Payer: Fidelis Medicare Advantage |
$2,756.25
|
Rate for Payer: Group Health Inc Commercial |
$1,312.50
|
Rate for Payer: Group Health Inc Medicare |
$918.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,312.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,312.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,706.25
|
|
ONYX FRONTIER CORONARY STENT
|
Facility
|
IP
|
$2,625.00
|
|
Service Code
|
HCPCS C1874
|
Hospital Charge Code |
66521446
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,312.50 |
Max. Negotiated Rate |
$1,312.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,312.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,312.50
|
|
OOPHORECTOMY
|
Facility
|
OP
|
$1,315.38
|
|
Service Code
|
HCPCS 58940
|
Hospital Charge Code |
40059985
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$460.38 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$723.46
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$664.04
|
Rate for Payer: Aetna Government |
$664.04
|
Rate for Payer: Brighton Health Commercial |
$986.54
|
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 |
$657.69
|
Rate for Payer: Group Health Inc Medicare |
$460.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$657.69
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$657.69
|
Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
OOPHORECTOMY, MALIGNANCY
|
Facility
|
OP
|
$2,997.53
|
|
Service Code
|
HCPCS 58943
|
Hospital Charge Code |
40052249
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,049.14 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,648.64
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,504.05
|
Rate for Payer: Aetna Government |
$1,504.05
|
Rate for Payer: Brighton Health Commercial |
$2,248.15
|
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 |
$1,498.76
|
Rate for Payer: Group Health Inc Medicare |
$1,049.14
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,498.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,498.76
|
Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
OOPHORECTOMY, PARTIAL OR TOTAL, U
|
Facility
|
OP
|
$7,566.13
|
|
Service Code
|
HCPCS 59160
|
Hospital Charge Code |
30102500
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$165.00 |
Max. Negotiated Rate |
$3,783.06 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
Rate for Payer: Aetna Government |
$3,615.39
|
Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
Rate for Payer: Brighton Health Commercial |
$874.00
|
Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
Rate for Payer: Cash Price |
$3,615.39
|
Rate for Payer: Cash Price |
$3,615.39
|
Rate for Payer: Cash Price |
$3,615.39
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
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 |
$3,615.39
|
Rate for Payer: EmblemHealth Commercial |
$525.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
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 |
$3,783.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
Rate for Payer: Healthfirst QHP |
$3,615.39
|
Rate for Payer: Humana Medicare |
$3,687.70
|
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
Rate for Payer: United Healthcare Commercial |
$569.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
OOPHORECTOMY, PARTIAL OR TOTAL, U
|
Facility
|
IP
|
$7,566.13
|
|
Service Code
|
HCPCS 59160
|
Hospital Charge Code |
30102500
|
Hospital Revenue Code
|
450
|
Rate for Payer: Cash Price |
$3,615.39
|
|
OPEN BONE BIOPSY
|
Facility
|
OP
|
$4,157.25
|
|
Service Code
|
HCPCS 20220
|
Hospital Charge Code |
40021550
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,188.00 |
Max. Negotiated Rate |
$3,117.94 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
Rate for Payer: Aetna Government |
$1,874.89
|
Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
Rate for Payer: Brighton Health Commercial |
$3,117.94
|
Rate for Payer: Cash Price |
$1,874.89
|
Rate for Payer: Cash Price |
$1,874.89
|
Rate for Payer: Cash Price |
$1,874.89
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
Rate for Payer: Elderplan Medicare Advantage |
$1,874.89
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
Rate for Payer: Healthfirst QHP |
$1,874.89
|
Rate for Payer: Humana Medicare |
$1,912.39
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
Rate for Payer: United Healthcare Commercial |
$1,188.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
OPEN BONE BIOPSY
|
Facility
|
IP
|
$4,157.25
|
|
Service Code
|
HCPCS 20220
|
Hospital Charge Code |
40021550
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$1,874.89
|
|
OPEN REDUCTION OF DISLOCATION TMJ
|
Facility
|
OP
|
$3,625.00
|
|
Service Code
|
HCPCS D7810
|
Hospital Charge Code |
42301940
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$1,268.75 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,993.75
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,322.76
|
Rate for Payer: Aetna Government |
$1,322.76
|
Rate for Payer: Brighton Health Commercial |
$2,718.75
|
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 |
$1,812.50
|
Rate for Payer: Group Health Inc Medicare |
$1,268.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,812.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,812.50
|
|
OPEN REDUCTN-MAXLRY FRACTURE
|
Facility
|
OP
|
$1,882.85
|
|
Service Code
|
HCPCS 21422
|
Hospital Charge Code |
40029820
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$941.42 |
Max. Negotiated Rate |
$6,907.65 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
Rate for Payer: Aetna Government |
$6,772.21
|
Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
Rate for Payer: Brighton Health Commercial |
$1,412.14
|
Rate for Payer: Cash Price |
$6,772.21
|
Rate for Payer: Cash Price |
$6,772.21
|
Rate for Payer: Cash Price |
$6,772.21
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
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 |
$6,772.21
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$941.42
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
Rate for Payer: Healthfirst QHP |
$6,772.21
|
Rate for Payer: Humana Medicare |
$6,907.65
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
Rate for Payer: United Healthcare Commercial |
$2,683.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
OPEN REDUCTN-MAXLRY FRACTURE
|
Facility
|
IP
|
$1,882.85
|
|
Service Code
|
HCPCS 21422
|
Hospital Charge Code |
40029820
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$6,772.21
|
|
OPEN RENAL BIOPSY
|
Facility
|
OP
|
$2,334.68
|
|
Service Code
|
HCPCS 50205
|
Hospital Charge Code |
40123025
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$817.14 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,284.07
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$955.41
|
Rate for Payer: Aetna Government |
$955.41
|
Rate for Payer: Brighton Health Commercial |
$1,751.01
|
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 |
$1,167.34
|
Rate for Payer: Group Health Inc Medicare |
$817.14
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,167.34
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,167.34
|
Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
OPEN TREAT KNUCKLE DISLOCATION
|
Facility
|
IP
|
$8,291.05
|
|
Service Code
|
HCPCS 26715
|
Hospital Charge Code |
30101226
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$3,743.15
|
|
OPEN TREAT KNUCKLE DISLOCATION
|
Facility
|
OP
|
$8,291.05
|
|
Service Code
|
HCPCS 26715
|
Hospital Charge Code |
30101226
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,468.00 |
Max. Negotiated Rate |
$6,218.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
Rate for Payer: Aetna Government |
$3,743.15
|
Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
Rate for Payer: Brighton Health Commercial |
$6,218.29
|
Rate for Payer: Cash Price |
$3,743.15
|
Rate for Payer: Cash Price |
$3,743.15
|
Rate for Payer: Cash Price |
$3,743.15
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
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 |
$3,743.15
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
Rate for Payer: Healthfirst QHP |
$3,743.15
|
Rate for Payer: Humana Medicare |
$3,818.01
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
Rate for Payer: United Healthcare Commercial |
$1,468.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
OPEN TREAT LOWER JAW FRACTURE
|
Facility
|
OP
|
$14,691.05
|
|
Service Code
|
HCPCS 21461
|
Hospital Charge Code |
40029659
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,505.00 |
Max. Negotiated Rate |
$11,018.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
Rate for Payer: Aetna Government |
$6,772.21
|
Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
Rate for Payer: Brighton Health Commercial |
$11,018.29
|
Rate for Payer: Cash Price |
$6,772.21
|
Rate for Payer: Cash Price |
$6,772.21
|
Rate for Payer: Cash Price |
$6,772.21
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
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 |
$6,772.21
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
Rate for Payer: Healthfirst QHP |
$6,772.21
|
Rate for Payer: Humana Medicare |
$6,907.65
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
Rate for Payer: United Healthcare Commercial |
$2,683.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
OPEN TREAT LOWER JAW FRACTURE
|
Facility
|
IP
|
$14,691.05
|
|
Service Code
|
HCPCS 21461
|
Hospital Charge Code |
40029659
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$6,772.21
|
|
OPEN TREATMENT FX FINGER
|
Facility
|
OP
|
$8,291.05
|
|
Service Code
|
HCPCS 26746
|
Hospital Charge Code |
40029422
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,468.00 |
Max. Negotiated Rate |
$6,218.29 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
Rate for Payer: Aetna Government |
$3,743.15
|
Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
Rate for Payer: Brighton Health Commercial |
$6,218.29
|
Rate for Payer: Cash Price |
$3,743.15
|
Rate for Payer: Cash Price |
$3,743.15
|
Rate for Payer: Cash Price |
$3,743.15
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
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 |
$3,743.15
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
Rate for Payer: Healthfirst QHP |
$3,743.15
|
Rate for Payer: Humana Medicare |
$3,818.01
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
Rate for Payer: United Healthcare Commercial |
$1,468.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
OPEN TREATMENT FX FINGER
|
Facility
|
IP
|
$8,291.05
|
|
Service Code
|
HCPCS 26746
|
Hospital Charge Code |
40029422
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$3,743.15
|
|
OPEN TREATMENT HUMERUS FRACTURE
|
Facility
|
OP
|
$36,044.28
|
|
Service Code
|
HCPCS 24579
|
Hospital Charge Code |
40029691
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,505.00 |
Max. Negotiated Rate |
$27,033.21 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,219.83
|
Rate for Payer: Aetna Government |
$15,219.83
|
Rate for Payer: Affinity Essential Plan 1&2 |
$10,653.88
|
Rate for Payer: Affinity Essential Plan 3&4 |
$10,653.88
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$10,653.88
|
Rate for Payer: Brighton Health Commercial |
$27,033.21
|
Rate for Payer: Cash Price |
$15,219.83
|
Rate for Payer: Cash Price |
$15,219.83
|
Rate for Payer: Cash Price |
$15,219.83
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15,219.83
|
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 |
$15,219.83
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$12,936.86
|
Rate for Payer: Fidelis Essential Plan QHP |
$13,545.65
|
Rate for Payer: Fidelis Medicare Advantage |
$15,219.83
|
Rate for Payer: Fidelis Qualified Health Plan |
$13,545.65
|
Rate for Payer: Group Health Inc Commercial |
$15,219.83
|
Rate for Payer: Group Health Inc Medicare |
$15,219.83
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,022.14
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$15,219.83
|
Rate for Payer: Healthfirst Medicare Advantage |
$12,936.86
|
Rate for Payer: Healthfirst QHP |
$15,219.83
|
Rate for Payer: Humana Medicare |
$15,524.23
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$15,219.83
|
Rate for Payer: United Healthcare Commercial |
$2,546.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$15,219.83
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,219.83
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,175.86
|
Rate for Payer: Wellcare Medicare |
$14,458.84
|
|
OPEN TREATMENT HUMERUS FRACTURE
|
Facility
|
IP
|
$36,044.28
|
|
Service Code
|
HCPCS 24579
|
Hospital Charge Code |
40029691
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$15,219.83
|
|