|
REG BONE SCREW 2.7MMX14MM
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$165.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$86.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$94.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.85
|
| Rate for Payer: EmblemHealth Commercial |
$79.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.90
|
| Rate for Payer: Group Health Inc Commercial |
$79.00
|
| Rate for Payer: Group Health Inc Medicare |
$55.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.70
|
|
|
REGIONAL BLOCK ANESTHESIA
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS D9211
|
| Hospital Charge Code |
42302290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.56
|
| Rate for Payer: Aetna Government |
$11.56
|
| Rate for Payer: Brighton Health Commercial |
$66.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$44.50
|
| Rate for Payer: Group Health Inc Medicare |
$31.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.50
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$38,858.41
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$12,944.00 |
| Max. Negotiated Rate |
$38,858.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,257.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,260.66
|
| Rate for Payer: Aetna Government |
$28,260.66
|
| Rate for Payer: Brighton Health Commercial |
$21,887.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,825.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,067.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,512.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,847.63
|
| Rate for Payer: EmblemHealth Commercial |
$12,944.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,260.66
|
| Rate for Payer: Group Health Inc Commercial |
$28,260.66
|
| Rate for Payer: Group Health Inc Medicare |
$28,260.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,260.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,141.21
|
| Rate for Payer: Humana Medicare |
$38,858.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,260.66
|
| Rate for Payer: United Healthcare Commercial |
$30,019.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,260.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,260.66
|
| Rate for Payer: Wellcare Medicare |
$26,847.63
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$29,385.61
|
|
|
Service Code
|
MSDRG 946
|
| Min. Negotiated Rate |
$8,683.90 |
| Max. Negotiated Rate |
$29,385.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,932.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,371.35
|
| Rate for Payer: Aetna Government |
$21,371.35
|
| Rate for Payer: Brighton Health Commercial |
$14,684.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,798.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,488.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,432.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,302.78
|
| Rate for Payer: EmblemHealth Commercial |
$8,683.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,371.35
|
| Rate for Payer: Group Health Inc Commercial |
$21,371.35
|
| Rate for Payer: Group Health Inc Medicare |
$21,371.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,371.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,937.68
|
| Rate for Payer: Humana Medicare |
$29,385.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,371.35
|
| Rate for Payer: United Healthcare Commercial |
$20,139.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,371.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,371.35
|
| Rate for Payer: Wellcare Medicare |
$20,302.78
|
|
|
REHAB PROGRAM PER 1/2 DAY
|
Facility
|
OP
|
$229.74
|
|
|
Service Code
|
HCPCS H2001
|
| Hospital Charge Code |
30400248
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$183.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.00
|
| Rate for Payer: Aetna Government |
$59.00
|
| Rate for Payer: Brighton Health Commercial |
$172.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.22
|
| Rate for Payer: Group Health Inc Commercial |
$114.87
|
| Rate for Payer: Group Health Inc Medicare |
$80.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.87
|
| Rate for Payer: United Healthcare Commercial |
$114.87
|
|
|
REIMPLANT OR STAB ACCID EVUL TOOT
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS D7270
|
| Hospital Charge Code |
42301690
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
REIMPLANT OR STAB ACCID EVUL TOOT
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS D7270
|
| Hospital Charge Code |
42301690
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$213.75
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
REINTUBATION
|
Facility
|
OP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
40011345
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$197.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$197.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$197.73
|
| Rate for Payer: Brighton Health Commercial |
$467.77
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| Rate for Payer: Group Health Inc Commercial |
$282.47
|
| Rate for Payer: Group Health Inc Medicare |
$282.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Humana Medicare |
$288.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
REINTUBATION
|
Facility
|
IP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
40011345
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
REISE EYELASHES
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 67820
|
| Hospital Charge Code |
30305954
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| 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: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| 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: 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 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 Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| 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: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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
|
|
|
REISE EYELASHES
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 67820
|
| Hospital Charge Code |
30305954
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
REJ SPT MOD NECK 38MMXV40 127/132
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,079.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,089.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,188.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$990.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,138.50
|
| Rate for Payer: EmblemHealth Commercial |
$990.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,079.00
|
| Rate for Payer: Group Health Inc Commercial |
$990.00
|
| Rate for Payer: Group Health Inc Medicare |
$693.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$990.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$990.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,287.00
|
|
|
REJ SPT MOD NECK 38MMXV40 127/132
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$990.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$990.00
|
|
|
REJUV. SPT MOD NECK 30MMXV40
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,030.00 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,030.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,030.00
|
|
|
REJUV. SPT MOD NECK 30MMXV40
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205242
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,163.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,133.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,236.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,030.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,184.50
|
| Rate for Payer: EmblemHealth Commercial |
$1,030.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,163.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,030.00
|
| Rate for Payer: Group Health Inc Medicare |
$721.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,030.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,030.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,339.00
|
|
|
RELEASE CONTRACTURE KNUCKLE
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26520
|
| Hospital Charge Code |
40029420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| 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
|
|
|
RELEASE CONTRACTURE KNUCKLE
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26520
|
| Hospital Charge Code |
40029420
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
RELEASE CONTRATURE ELBOW
|
Facility
|
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 24149
|
| Hospital Charge Code |
40029524
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,588.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,588.37
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
RELEASE CONTRATURE ELBOW
|
Facility
|
IP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 24149
|
| Hospital Charge Code |
40029524
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
RELEASE CONTRATURE PALM
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26121
|
| Hospital Charge Code |
40019523
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| 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 |
$1,835.00
|
| 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
|
|
|
RELEASE CONTRATURE PALM
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26121
|
| Hospital Charge Code |
40019523
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
RELEASE CONTRATURE THUMB
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26508
|
| Hospital Charge Code |
40019525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| 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
|
|
|
RELEASE CONTRATURE THUMB
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26508
|
| Hospital Charge Code |
40019525
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
RELEASE EYE TISSUE
|
Facility
|
OP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67343
|
| Hospital Charge Code |
40074165
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,395.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,702.32
|
| Rate for Payer: Aetna Government |
$2,702.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,891.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,891.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,891.62
|
| Rate for Payer: Brighton Health Commercial |
$4,395.92
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,702.32
|
| 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 |
$2,702.32
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,296.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,405.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,702.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,405.06
|
| Rate for Payer: Group Health Inc Commercial |
$2,702.32
|
| Rate for Payer: Group Health Inc Medicare |
$2,702.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,296.97
|
| Rate for Payer: Healthfirst QHP |
$2,702.32
|
| Rate for Payer: Humana Medicare |
$2,756.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,702.32
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,702.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,702.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,161.86
|
| Rate for Payer: Wellcare Medicare |
$2,567.20
|
|
|
RELEASE EYE TISSUE
|
Facility
|
IP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67343
|
| Hospital Charge Code |
40074165
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,702.32
|
|
