|
STR 3.5X24MM NON LK SCREW
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
|
|
STR 3.5X24MM NON LK SCREW
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008280
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
| 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 |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.00
|
| Rate for Payer: Group Health Inc Commercial |
$40.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
|
|
STR 3.5X70MM CORT SCREW
|
Facility
OP
|
$320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.00
|
| 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 |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.00
|
| Rate for Payer: Group Health Inc Commercial |
$160.00
|
| Rate for Payer: Group Health Inc Medicare |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.00
|
|
|
STR 3.5X70MM CORT SCREW
|
Facility
IP
|
$320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
|
|
STR 4 HL FRACT PLT W/SPAN
|
Facility
IP
|
$591.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$295.68 |
| Max. Negotiated Rate |
$295.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.68
|
|
|
STR 4 HL FRACT PLT W/SPAN
|
Facility
OP
|
$591.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$620.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$325.25
|
| 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 |
$295.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$620.93
|
| Rate for Payer: Group Health Inc Commercial |
$295.68
|
| Rate for Payer: Group Health Inc Medicare |
$206.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$384.38
|
|
|
STR 5HL L PLT 5MM ADVMT100DRT STD
|
Facility
OP
|
$709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$744.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$390.22
|
| 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 |
$354.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$407.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$744.98
|
| Rate for Payer: Group Health Inc Commercial |
$354.75
|
| Rate for Payer: Group Health Inc Medicare |
$248.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.18
|
|
|
STR 5HL L PLT 5MM ADVMT100DRT STD
|
Facility
IP
|
$709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204678
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.75 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.75
|
|
|
STR 8MM PLT 11HL LEFORT 1 ADV RT
|
Facility
IP
|
$709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.75 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.75
|
|
|
STR 8MM PLT 11HL LEFORT 1 ADV RT
|
Facility
OP
|
$709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204677
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$744.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$390.22
|
| 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 |
$354.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$407.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$744.98
|
| Rate for Payer: Group Health Inc Commercial |
$354.75
|
| Rate for Payer: Group Health Inc Medicare |
$248.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.18
|
|
|
STRAIGHT MINI DRILL
|
Facility
OP
|
$487.50
|
|
| Hospital Charge Code |
64907192
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$170.62 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$268.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$243.75
|
| Rate for Payer: Aetna Government |
$243.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$390.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$331.50
|
| Rate for Payer: Group Health Inc Commercial |
$243.75
|
| Rate for Payer: Group Health Inc Medicare |
$170.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.75
|
|
|
STRAP ANKLE OR FOOT
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.70 |
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$182.22
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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 |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.70
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| 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 |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| 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
|
|
|
STRAP HEAD CPAP
|
Facility
OP
|
$15.90
|
|
| Hospital Charge Code |
64902267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$12.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.95
|
| Rate for Payer: Aetna Government |
$7.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.81
|
| Rate for Payer: Group Health Inc Commercial |
$7.95
|
| Rate for Payer: Group Health Inc Medicare |
$5.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.95
|
|
|
STRAP KNEE CHO-PAT LGE 14.5-16.5
|
Facility
OP
|
$31.95
|
|
| Hospital Charge Code |
64902837
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$25.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.98
|
| Rate for Payer: Aetna Government |
$15.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.73
|
| Rate for Payer: Group Health Inc Commercial |
$15.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.98
|
|
|
STRAP KNEE CHO-PAT MED 12.5-14.5
|
Facility
OP
|
$31.95
|
|
| Hospital Charge Code |
64902850
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$25.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.98
|
| Rate for Payer: Aetna Government |
$15.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.73
|
| Rate for Payer: Group Health Inc Commercial |
$15.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.98
|
|
|
STRAP KNEE CHO-PAT SM 10-12-1/2
|
Facility
OP
|
$31.95
|
|
| Hospital Charge Code |
64902848
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$25.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.98
|
| Rate for Payer: Aetna Government |
$15.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.73
|
| Rate for Payer: Group Health Inc Commercial |
$15.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.98
|
|
|
STRAP KNEE CHO-PAT XSM 10-12-1/2
|
Facility
OP
|
$31.95
|
|
| Hospital Charge Code |
64902846
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$25.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.98
|
| Rate for Payer: Aetna Government |
$15.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.73
|
| Rate for Payer: Group Health Inc Commercial |
$15.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.98
|
|
|
STRAPPING OF ANKLE
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
30301129
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.70 |
| 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 |
$18.70
|
| 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 |
$20.78
|
| 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
|
|
|
STRAPPING OF ELBOW OR WRIST
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
30301128
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
STRAPPING OF HAND OR FINGER
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
30301144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
STRAPPING OF SHOULDER
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
30301127
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
STRAPPING OF TOE
|
Facility
OP
|
$170.35
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
30106513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$70.74
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$85.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
STRAPPING OF TOES
|
Facility
OP
|
$170.35
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
30301173
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$85.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
Strapping; Unna boot
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 29580
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.56 |
| 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: 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 |
$182.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.56
|
| 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 Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.73
|
| 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
|
|
|
STRAPS,ARMBOARD FREEDOM
|
Facility
OP
|
$56.55
|
|
| Hospital Charge Code |
64905512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.28
|
| Rate for Payer: Aetna Government |
$28.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.45
|
| Rate for Payer: Group Health Inc Commercial |
$28.28
|
| Rate for Payer: Group Health Inc Medicare |
$19.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.28
|
|
