|
SP LIMITED REN/MESE/POR ABD
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93976 TC
|
| Hospital Charge Code |
41201173
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$118.81 |
| 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 |
$134.85
|
| 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 |
$149.83
|
|
|
SP LIMITED UE ARTERIAL
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93931 TC
|
| Hospital Charge Code |
41201169
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.30 |
| 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 |
$112.30
|
| 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 |
$124.78
|
|
|
SPLINT 1000-2000
|
Facility
OP
|
$1,500.00
|
|
| Hospital Charge Code |
40203016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$825.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$750.00
|
| Rate for Payer: Aetna Government |
$750.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,020.00
|
| Rate for Payer: Group Health Inc Commercial |
$750.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.00
|
|
|
SPLINT 100-499
|
Facility
OP
|
$300.00
|
|
| Hospital Charge Code |
40203014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.00
|
| Rate for Payer: Aetna Government |
$150.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: Group Health Inc Commercial |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
|
|
SPLINT 500-1000
|
Facility
OP
|
$750.00
|
|
| Hospital Charge Code |
40203015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$412.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$375.00
|
| Rate for Payer: Aetna Government |
$375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$510.00
|
| Rate for Payer: Group Health Inc Commercial |
$375.00
|
| Rate for Payer: Group Health Inc Medicare |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.00
|
|
|
SPLINT APPLICATION LONG
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
30302026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
SPLINT APPLICATION LONG
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
40023230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.22
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$182.22
|
| Rate for Payer: Group Health Inc Medicare |
$182.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
SPLINT APPLICATION SHORT
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29505
|
| Hospital Charge Code |
40023231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.22
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$182.22
|
| Rate for Payer: Group Health Inc Medicare |
$182.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
SPLINT CLAVICLE LG.
|
Facility
OP
|
$10.65
|
|
| Hospital Charge Code |
64902272
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.32
|
| Rate for Payer: Aetna Government |
$5.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.24
|
| Rate for Payer: Group Health Inc Commercial |
$5.32
|
| Rate for Payer: Group Health Inc Medicare |
$3.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.32
|
|
|
SPLINT CLAVICLE MED.
|
Facility
OP
|
$10.97
|
|
| Hospital Charge Code |
64902270
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.48
|
| Rate for Payer: Aetna Government |
$5.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.46
|
| Rate for Payer: Group Health Inc Commercial |
$5.48
|
| Rate for Payer: Group Health Inc Medicare |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.48
|
|
|
SPLINT CLAVICLE SM.
|
Facility
OP
|
$20.81
|
|
| Hospital Charge Code |
64902268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.15
|
| Rate for Payer: Group Health Inc Commercial |
$10.40
|
| Rate for Payer: Group Health Inc Medicare |
$7.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.40
|
|
|
SPLINT COCK UP LEFT LARGE
|
Facility
OP
|
$15.88
|
|
| Hospital Charge Code |
64901216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.94
|
| Rate for Payer: Aetna Government |
$7.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.80
|
| Rate for Payer: Group Health Inc Commercial |
$7.94
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.94
|
|
|
SPLINT COCK UP LEFT MEDIUM
|
Facility
OP
|
$15.88
|
|
| Hospital Charge Code |
64901218
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.94
|
| Rate for Payer: Aetna Government |
$7.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.80
|
| Rate for Payer: Group Health Inc Commercial |
$7.94
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.94
|
|
|
SPLINT COCK UP LEFT SMALL
|
Facility
OP
|
$15.88
|
|
| Hospital Charge Code |
64901220
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.94
|
| Rate for Payer: Aetna Government |
$7.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.80
|
| Rate for Payer: Group Health Inc Commercial |
$7.94
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.94
|
|
|
SPLINT COCK UP RIGHT LARGE
|
Facility
OP
|
$15.88
|
|
| Hospital Charge Code |
64901194
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.94
|
| Rate for Payer: Aetna Government |
$7.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.80
|
| Rate for Payer: Group Health Inc Commercial |
$7.94
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.94
|
|
|
SPLINT COCK UP RIGHT MEDIUM DERTX
|
Facility
OP
|
$15.88
|
|
| Hospital Charge Code |
64901196
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.94
|
| Rate for Payer: Aetna Government |
$7.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.80
|
| Rate for Payer: Group Health Inc Commercial |
$7.94
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.94
|
|
|
SPLINT COCK UP RIGHT SMALL
|
Facility
OP
|
$15.88
|
|
| Hospital Charge Code |
64901222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$12.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.94
|
| Rate for Payer: Aetna Government |
$7.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.80
|
| Rate for Payer: Group Health Inc Commercial |
$7.94
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.94
|
|
|
SPLINT DENVER NASAL
|
Facility
OP
|
$123.00
|
|
| Hospital Charge Code |
64904568
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$98.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.50
|
| Rate for Payer: Aetna Government |
$61.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$98.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.64
|
| Rate for Payer: Group Health Inc Commercial |
$61.50
|
| Rate for Payer: Group Health Inc Medicare |
$43.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.50
|
|
|
SPLINT,FIBERGLASS,ORTHO,4X15'
|
Facility
OP
|
$155.14
|
|
| Hospital Charge Code |
64902400
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$124.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.57
|
| Rate for Payer: Aetna Government |
$77.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.50
|
| Rate for Payer: Group Health Inc Commercial |
$77.57
|
| Rate for Payer: Group Health Inc Medicare |
$54.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.57
|
|
|
SPLINT,FIBERGLASS,ORTHO,5X15Y
|
Facility
OP
|
$182.71
|
|
| Hospital Charge Code |
64902402
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$146.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.36
|
| Rate for Payer: Aetna Government |
$91.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.24
|
| Rate for Payer: Group Health Inc Commercial |
$91.36
|
| Rate for Payer: Group Health Inc Medicare |
$63.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.36
|
|
|
SPLINT,FIBERGLASS,ORTHO,6X15
|
Facility
OP
|
$282.35
|
|
| Hospital Charge Code |
64902405
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.82 |
| Max. Negotiated Rate |
$225.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$155.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$141.18
|
| Rate for Payer: Aetna Government |
$141.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$192.00
|
| Rate for Payer: Group Health Inc Commercial |
$141.18
|
| Rate for Payer: Group Health Inc Medicare |
$98.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.18
|
|
|
SPLINT FINGER ASSORTMENT
|
Facility
OP
|
$5.96
|
|
| Hospital Charge Code |
64901566
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
| Rate for Payer: Aetna Government |
$2.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.05
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
|
|
SPLINT RESTING WIRE-FOAM RL
|
Facility
OP
|
$147.28
|
|
| Hospital Charge Code |
64903197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$117.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.64
|
| Rate for Payer: Aetna Government |
$73.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$117.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.15
|
| Rate for Payer: Group Health Inc Commercial |
$73.64
|
| Rate for Payer: Group Health Inc Medicare |
$51.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.64
|
|
|
SPLINT SEPTAL NEIMAN
|
Facility
OP
|
$72.00
|
|
| Hospital Charge Code |
40205969
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.00
|
| Rate for Payer: Aetna Government |
$36.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.96
|
| Rate for Payer: Group Health Inc Commercial |
$36.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.00
|
|
|
SPLINT SEPTAL NEIMAN
|
Facility
OP
|
$53.53
|
|
| Hospital Charge Code |
64903027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.76
|
| Rate for Payer: Aetna Government |
$26.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.40
|
| Rate for Payer: Group Health Inc Commercial |
$26.76
|
| Rate for Payer: Group Health Inc Medicare |
$18.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.76
|
|
