|
RT US GUIDE INTRSTTL RADLMNT APP
|
Facility
OP
|
$1,250.92
|
|
|
Service Code
|
HCPCS 76965 TC
|
| Hospital Charge Code |
66541309
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$1,000.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$688.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$625.46
|
| Rate for Payer: Aetna Government |
$625.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,000.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$850.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$625.46
|
| Rate for Payer: Group Health Inc Medicare |
$437.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$625.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.64
|
|
|
RT US PLAN
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76873 TC
|
| Hospital Charge Code |
66541304
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$110.45 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.45
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.72
|
|
|
RT VENIPUNCTURE
|
Facility
OP
|
$9.71
|
|
|
Service Code
|
HCPCS 36415
|
| Hospital Charge Code |
66541216
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$926.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.57
|
| Rate for Payer: Aetna Government |
$8.57
|
| Rate for Payer: Amida Care Medicaid |
$9.26
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.57
|
| Rate for Payer: EmblemHealth Commercial |
$8.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Group Health Inc Commercial |
$8.57
|
| Rate for Payer: Group Health Inc Medicare |
$8.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.26
|
| Rate for Payer: Healthfirst Essential Plan |
$20.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.28
|
| Rate for Payer: Healthfirst QHP |
$9.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.26
|
| Rate for Payer: SOMOS Essential |
$20.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.86
|
| Rate for Payer: Wellcare Medicare |
$7.71
|
|
|
RT WHEN PRESCRIBED BY MD
|
Facility
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77331 TC
|
| Hospital Charge Code |
66541259
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.70
|
| Rate for Payer: Aetna Government |
$191.70
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$191.70
|
| Rate for Payer: Group Health Inc Medicare |
$134.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.78
|
|
|
RUBBER PANTS
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40205620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
RUBELLA ANTIBODIES, IGG
|
Facility
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
40729377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
RUBELLA ANTIBODIES, IGM
|
Facility
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
40729378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
RUBELLA-SCREENING
|
Facility
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86762
|
| Hospital Charge Code |
40614055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
RUBEOLA ANTIBODIES, IGG
|
Facility
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
40729379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
RUBEOLA ANTIBODIES, IGM
|
Facility
OP
|
$32.20
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
40729380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
RUN-THROUGH NS GUIDE WIRE
|
Facility
IP
|
$170.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66526605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.00
|
|
|
RUN-THROUGH NS GUIDE WIRE
|
Facility
OP
|
$170.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66526605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$97.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$178.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.00
|
| Rate for Payer: Group Health Inc Medicare |
$59.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.50
|
|
|
RUSCH CATHETER 14FR 2WAY 5CC
|
Facility
OP
|
$52.66
|
|
| Hospital Charge Code |
64905183
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$42.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.33
|
| Rate for Payer: Aetna Government |
$26.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.81
|
| Rate for Payer: Group Health Inc Commercial |
$26.33
|
| Rate for Payer: Group Health Inc Medicare |
$18.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.33
|
|
|
RUSCH CATHETHER 12 FR. 2 WAY
|
Facility
OP
|
$52.66
|
|
| Hospital Charge Code |
64905181
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$42.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.33
|
| Rate for Payer: Aetna Government |
$26.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.81
|
| Rate for Payer: Group Health Inc Commercial |
$26.33
|
| Rate for Payer: Group Health Inc Medicare |
$18.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.33
|
|
|
RVS EYELASHES BY OTH THN FORCEPS
|
Facility
OP
|
$794.85
|
|
|
Service Code
|
HCPCS 67825
|
| Hospital Charge Code |
30305361
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.57 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$336.88
|
| Rate for Payer: Aetna Government |
$336.88
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.88
|
| 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 |
$336.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.82
|
| 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 |
$397.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.35
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$320.04
|
|
|
RVW MEDS BY RX/DR IN RCRD
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 1160F
|
| Hospital Charge Code |
30305811
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| 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: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
RX90 CEMENTED FEMORAL 11.0X125MM
|
Facility
OP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,872.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,552.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,668.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,872.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,320.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,016.00
|
|
|
RX90 CEMENTED FEMORAL 11.0X125MM
|
Facility
IP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202209
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,320.00 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
|
|
RX90 CEMENTED FEMORAL 13.0X35MM
|
Facility
IP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,320.00 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
|
|
RX90 CEMENTED FEMORAL 13.0X35MM
|
Facility
OP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209911
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,872.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,552.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,668.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,872.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,320.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,016.00
|
|
|
RX90 CEMENTED FEMORAL 9.0X115MM
|
Facility
OP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,872.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,552.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,668.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,872.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,320.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,016.00
|
|
|
RX90 CEMENTED FEMORAL 9.0X115MM
|
Facility
IP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,320.00 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
|
|
RX90 CEMENTED FEMORAL 9.0X35MM
|
Facility
OP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,872.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,552.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,668.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,872.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,320.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,016.00
|
|
|
RX90 CEMENTED FEMORAL 9.0X35MM
|
Facility
IP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209912
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,320.00 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
|
|
RX90 CENTRAL SLEEVE FEMOR13X1.5MM
|
Facility
OP
|
$640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209996
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$352.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$368.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$672.00
|
| Rate for Payer: Group Health Inc Commercial |
$320.00
|
| Rate for Payer: Group Health Inc Medicare |
$224.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.00
|
|
