|
BARD VENTRIO H/P 11.4CM X11.4CM
|
Facility
OP
|
$2,179.84
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40207041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$2,288.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,198.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,089.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,253.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,288.83
|
| Rate for Payer: Group Health Inc Commercial |
$1,089.92
|
| Rate for Payer: Group Health Inc Medicare |
$762.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,089.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,089.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,416.90
|
|
|
BARI AIR THERAPY SYSTEM
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
40209311
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
BARIKARE BARIATRIC BED
|
Facility
OP
|
$260.00
|
|
| Hospital Charge Code |
40209312
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.00
|
| Rate for Payer: Aetna Government |
$130.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.80
|
| Rate for Payer: Group Health Inc Commercial |
$130.00
|
| Rate for Payer: Group Health Inc Medicare |
$91.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.00
|
|
|
BARIMAXX II BED
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
40209310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
BARIUM SULFATE 2% SUSP 450 ML
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41644427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
BARIUM SULFATE 2% SUSP 450 ML
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41654427
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
BARIUM SULFATE 2% SUSP 900 ML
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
41643815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.00
|
| Rate for Payer: Aetna Government |
$11.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.96
|
| Rate for Payer: Group Health Inc Commercial |
$11.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.30
|
|
|
BARIUM SULFATE 2% SUSP 900 ML
|
Facility
OP
|
$22.00
|
|
| Hospital Charge Code |
41653815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$17.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.00
|
| Rate for Payer: Aetna Government |
$11.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.96
|
| Rate for Payer: Group Health Inc Commercial |
$11.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.30
|
|
|
BARRIER ADHESION SEPRAFILM 5X6
|
Facility
OP
|
$727.31
|
|
| Hospital Charge Code |
64903989
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$254.56 |
| Max. Negotiated Rate |
$581.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$400.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$363.66
|
| Rate for Payer: Aetna Government |
$363.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$581.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$494.57
|
| Rate for Payer: Group Health Inc Commercial |
$363.66
|
| Rate for Payer: Group Health Inc Medicare |
$254.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$363.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$363.66
|
|
|
BARRIER INTERCEED ABSORB ADH 3X4
|
Facility
OP
|
$791.46
|
|
| Hospital Charge Code |
64904158
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$277.01 |
| Max. Negotiated Rate |
$633.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$435.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$395.73
|
| Rate for Payer: Aetna Government |
$395.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$633.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$538.19
|
| Rate for Payer: Group Health Inc Commercial |
$395.73
|
| Rate for Payer: Group Health Inc Medicare |
$277.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.73
|
|
|
BARRIER, NI, CTF,W/TAPE
|
Facility
OP
|
$7.19
|
|
| Hospital Charge Code |
40201976
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.60
|
| Rate for Payer: Aetna Government |
$3.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.89
|
| Rate for Payer: Group Health Inc Commercial |
$3.60
|
| Rate for Payer: Group Health Inc Medicare |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.60
|
|
|
BARRIER, NI, CTF, W/TAPE, 4FL
|
Facility
OP
|
$35.95
|
|
| Hospital Charge Code |
64903928
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$28.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.98
|
| Rate for Payer: Aetna Government |
$17.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.45
|
| Rate for Payer: Group Health Inc Commercial |
$17.98
|
| Rate for Payer: Group Health Inc Medicare |
$12.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.98
|
|
|
BARRIER OPST PST-OP VZ 25X10CM
|
Facility
OP
|
$97.85
|
|
| Hospital Charge Code |
64906300
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.92
|
| Rate for Payer: Aetna Government |
$48.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.54
|
| Rate for Payer: Group Health Inc Commercial |
$48.92
|
| Rate for Payer: Group Health Inc Medicare |
$34.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.92
|
|
|
BARRIER SKIN STOMA MEDIUM 2-1/4
|
Facility
OP
|
$3.40
|
|
| Hospital Charge Code |
64901334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
|
|
BARRIER, SKIN STOMA MEDIUM 2-1/4
|
Facility
OP
|
$1.20
|
|
| Hospital Charge Code |
40201978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
|
|
BARRIER SKIN STOMA SMALL 1-3/4
|
Facility
OP
|
$3.40
|
|
| Hospital Charge Code |
64901331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
|
|
BARRIER, SKIN STOMA SMALL 1-3/4
|
Facility
OP
|
$1.20
|
|
| Hospital Charge Code |
40201977
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
|
|
BARRIER SKIN STOMA X-LARG 2-3/4
|
Facility
OP
|
$3.40
|
|
| Hospital Charge Code |
64901335
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.70
|
| Rate for Payer: Aetna Government |
$1.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$1.70
|
| Rate for Payer: Group Health Inc Medicare |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.70
|
|
|
BARRIER, SKN, 70MM, 2.75FLG, 51M
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
64902141
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
|
|
BARTONELLA ANTIBODY PANEL
|
Facility
OP
|
$25.45
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
40729348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.18
|
| Rate for Payer: Healthfirst QHP |
$10.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.14
|
| Rate for Payer: Wellcare Medicare |
$9.16
|
|
|
BARTONELLA HENSELAE IGG/M
|
Facility
OP
|
$25.45
|
|
|
Service Code
|
HCPCS 86611
|
| Hospital Charge Code |
40729849
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.18
|
| Rate for Payer: Healthfirst QHP |
$10.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.14
|
| Rate for Payer: Wellcare Medicare |
$9.16
|
|
|
BASEPLATE TIBIAL
|
Facility
OP
|
$11,175.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$11,733.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,146.25
|
| 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 |
$5,587.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,425.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,733.75
|
| Rate for Payer: Group Health Inc Commercial |
$5,587.50
|
| Rate for Payer: Group Health Inc Medicare |
$3,911.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,587.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,587.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,263.75
|
|
|
BASEPLATE TIBIAL
|
Facility
IP
|
$11,175.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,587.50 |
| Max. Negotiated Rate |
$5,587.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,587.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,587.50
|
|
|
BASEPLATE TIBIAL CEMENTED SZ 6
|
Facility
IP
|
$3,935.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,967.62 |
| Max. Negotiated Rate |
$1,967.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,967.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,967.62
|
|
|
BASEPLATE TIBIAL CEMENTED SZ 6
|
Facility
OP
|
$3,935.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903667
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,132.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,164.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,967.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,262.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,132.01
|
| Rate for Payer: Group Health Inc Commercial |
$1,967.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,377.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,967.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,967.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,557.91
|
|
