|
Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete
|
Facility
|
OP
|
$6,907.65
|
|
|
Service Code
|
CPT 21249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,907.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
RECONSTRUCTION PLTE,12HLE,L144MM
|
Facility
|
OP
|
$760.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$798.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$418.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$456.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$380.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$437.12
|
| Rate for Payer: EmblemHealth Commercial |
$380.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$798.21
|
| Rate for Payer: Group Health Inc Commercial |
$380.10
|
| Rate for Payer: Group Health Inc Medicare |
$266.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$494.13
|
|
|
RECONSTRUCTION PLTE,12HLE,L144MM
|
Facility
|
IP
|
$760.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$380.10 |
| Max. Negotiated Rate |
$380.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.10
|
|
|
RECONSTRUCTION POLYDACTLY
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
40029581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
RECONSTRUCTION POLYDACTLY
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26587
|
| Hospital Charge Code |
40029581
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
RECONSTRUCTION TOE POLYDACTYLY
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
40029646
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
RECONSTRUCTION TOE POLYDACTYLY
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28344
|
| Hospital Charge Code |
40029646
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
RECONSTRUCT MIDFACE LEFORT
|
Facility
|
OP
|
$3,642.35
|
|
|
Service Code
|
HCPCS 21142
|
| Hospital Charge Code |
40019890
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,907.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Brighton Health Commercial |
$2,731.76
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,821.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
RECONSTRUCT MIDFACE LEFORT
|
Facility
|
IP
|
$3,642.35
|
|
|
Service Code
|
HCPCS 21142
|
| Hospital Charge Code |
40019890
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,772.21
|
|
|
RECON T2 LT 15 X 400 X 125
|
Facility
|
OP
|
$2,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,848.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,492.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,627.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,356.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,559.98
|
| Rate for Payer: EmblemHealth Commercial |
$1,356.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,848.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,356.50
|
| Rate for Payer: Group Health Inc Medicare |
$949.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,356.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,356.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.45
|
|
|
RECON T2 LT 15 X 400 X 125
|
Facility
|
IP
|
$2,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,356.50 |
| Max. Negotiated Rate |
$1,356.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,356.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,356.50
|
|
|
RECON TISSUE 16X20
|
Facility
|
IP
|
$28,385.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
64904845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,192.50 |
| Max. Negotiated Rate |
$14,192.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14,192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,192.50
|
|
|
RECON TISSUE 16X20
|
Facility
|
OP
|
$28,385.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
64904845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,879.82 |
| Max. Negotiated Rate |
$29,804.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,611.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,879.82
|
| Rate for Payer: Aetna Government |
$1,879.82
|
| Rate for Payer: Brighton Health Commercial |
$17,031.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,192.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,321.38
|
| Rate for Payer: EmblemHealth Commercial |
$14,192.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,804.25
|
| Rate for Payer: Group Health Inc Commercial |
$14,192.50
|
| Rate for Payer: Group Health Inc Medicare |
$9,934.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14,192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,192.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,450.25
|
|
|
RECORD HEART RYTHM
|
Facility
|
OP
|
$84.05
|
|
|
Service Code
|
HCPCS 93298
|
| Hospital Charge Code |
30305060
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.68
|
| Rate for Payer: Aetna Government |
$22.68
|
| Rate for Payer: Brighton Health Commercial |
$63.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.15
|
| Rate for Payer: Group Health Inc Commercial |
$42.02
|
| Rate for Payer: Group Health Inc Medicare |
$29.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.02
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
RECOVERY ROOM TIME 0-30 MIN
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
41543800
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.00
|
| Rate for Payer: Aetna Government |
$75.00
|
| Rate for Payer: Brighton Health Commercial |
$112.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.00
|
| Rate for Payer: Group Health Inc Commercial |
$75.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
|
|
RECOVERY ROOM TIME 121-479 MIN
|
Facility
|
OP
|
$600.00
|
|
| Hospital Charge Code |
41543803
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.00
|
| Rate for Payer: Aetna Government |
$300.00
|
| Rate for Payer: Brighton Health Commercial |
$450.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
|
|
RECOVERY ROOM TIME 31-60 MIN
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
41543801
|
|
Hospital Revenue Code
|
710
|
| 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: Brighton Health Commercial |
$225.00
|
| 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
|
|
|
RECOVERY ROOM TIME 480-720 MIN
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
41543804
|
|
Hospital Revenue Code
|
710
|
| 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: Brighton Health Commercial |
$562.50
|
| 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
|
|
|
RECOVERY ROOM TIME 61-120 MIN
|
Facility
|
OP
|
$450.00
|
|
| Hospital Charge Code |
41543802
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Brighton Health Commercial |
$337.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
|
|
RECOVERY ROOM TIME 720 OR GREATER
|
Facility
|
OP
|
$900.00
|
|
| Hospital Charge Code |
41543805
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$495.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$450.00
|
| Rate for Payer: Aetna Government |
$450.00
|
| Rate for Payer: Brighton Health Commercial |
$675.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$720.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$612.00
|
| Rate for Payer: Group Health Inc Commercial |
$450.00
|
| Rate for Payer: Group Health Inc Medicare |
$315.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.00
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$49,726.96
|
|
|
Service Code
|
MSDRG 333
|
| Min. Negotiated Rate |
$16,816.75 |
| Max. Negotiated Rate |
$49,726.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30,662.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,165.06
|
| Rate for Payer: Aetna Government |
$36,165.06
|
| Rate for Payer: Brighton Health Commercial |
$30,152.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36,888.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35,910.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29,635.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,356.81
|
| Rate for Payer: EmblemHealth Commercial |
$17,831.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,165.06
|
| Rate for Payer: Group Health Inc Commercial |
$36,165.06
|
| Rate for Payer: Group Health Inc Medicare |
$36,165.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,165.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,816.75
|
| Rate for Payer: Humana Medicare |
$49,726.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,165.06
|
| Rate for Payer: United Healthcare Commercial |
$41,355.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,165.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,165.06
|
| Rate for Payer: Wellcare Medicare |
$34,356.81
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$79,754.73
|
|
|
Service Code
|
MSDRG 332
|
| Min. Negotiated Rate |
$26,971.60 |
| Max. Negotiated Rate |
$79,754.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53,488.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$58,003.44
|
| Rate for Payer: Aetna Government |
$58,003.44
|
| Rate for Payer: Brighton Health Commercial |
$52,600.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59,163.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63,106.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52,077.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$55,103.27
|
| Rate for Payer: EmblemHealth Commercial |
$31,106.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$58,003.44
|
| Rate for Payer: Group Health Inc Commercial |
$58,003.44
|
| Rate for Payer: Group Health Inc Medicare |
$58,003.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58,003.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,971.60
|
| Rate for Payer: Humana Medicare |
$79,754.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58,003.44
|
| Rate for Payer: United Healthcare Commercial |
$72,673.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58,003.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58,003.44
|
| Rate for Payer: Wellcare Medicare |
$55,103.27
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$40,681.29
|
|
|
Service Code
|
MSDRG 334
|
| Min. Negotiated Rate |
$13,757.67 |
| Max. Negotiated Rate |
$40,681.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,667.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,586.39
|
| Rate for Payer: Aetna Government |
$29,586.39
|
| Rate for Payer: Brighton Health Commercial |
$23,273.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,178.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,718.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,874.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,107.07
|
| Rate for Payer: EmblemHealth Commercial |
$13,763.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,586.39
|
| Rate for Payer: Group Health Inc Commercial |
$29,586.39
|
| Rate for Payer: Group Health Inc Medicare |
$29,586.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,586.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,757.67
|
| Rate for Payer: Humana Medicare |
$40,681.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,586.39
|
| Rate for Payer: United Healthcare Commercial |
$31,920.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,586.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,586.39
|
| Rate for Payer: Wellcare Medicare |
$28,107.07
|
|
|
RECTAL TUBE
|
Facility
|
OP
|
$5.67
|
|
| Hospital Charge Code |
40205490
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.84
|
| Rate for Payer: Aetna Government |
$2.84
|
| Rate for Payer: Brighton Health Commercial |
$4.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.86
|
| Rate for Payer: Group Health Inc Commercial |
$2.84
|
| Rate for Payer: Group Health Inc Medicare |
$1.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.84
|
|
|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$36,839.12
|
|
|
Service Code
|
MSDRG 811
|
| Min. Negotiated Rate |
$12,035.90 |
| Max. Negotiated Rate |
$36,839.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,696.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,792.09
|
| Rate for Payer: Aetna Government |
$26,792.09
|
| Rate for Payer: Brighton Health Commercial |
$20,352.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,327.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,238.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,002.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,452.49
|
| Rate for Payer: EmblemHealth Commercial |
$12,035.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,792.09
|
| Rate for Payer: Group Health Inc Commercial |
$26,792.09
|
| Rate for Payer: Group Health Inc Medicare |
$26,792.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,792.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,458.32
|
| Rate for Payer: Humana Medicare |
$36,839.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,792.09
|
| Rate for Payer: United Healthcare Commercial |
$27,913.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,792.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,792.09
|
| Rate for Payer: Wellcare Medicare |
$25,452.49
|
|
