|
SYSTEM IMP FIX
|
Facility
IP
|
$1,812.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907364
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.25 |
| Max. Negotiated Rate |
$906.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$906.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$906.25
|
|
|
SYSTEM, INSULATED PD ACC BV TP
|
Facility
OP
|
$1,100.00
|
|
| Hospital Charge Code |
64905046
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$605.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$550.00
|
| Rate for Payer: Aetna Government |
$550.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$880.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$748.00
|
| Rate for Payer: Group Health Inc Commercial |
$550.00
|
| Rate for Payer: Group Health Inc Medicare |
$385.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$550.00
|
|
|
SYSTEM IRRIGATION VITAL VUE EXTD
|
Facility
OP
|
$486.80
|
|
| Hospital Charge Code |
64904397
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$170.38 |
| Max. Negotiated Rate |
$389.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$267.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$243.40
|
| Rate for Payer: Aetna Government |
$243.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$389.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$331.02
|
| Rate for Payer: Group Health Inc Commercial |
$243.40
|
| Rate for Payer: Group Health Inc Medicare |
$170.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.40
|
|
|
SYSTEM IRRIGATION VITAL VUE EXTD
|
Facility
OP
|
$402.38
|
|
| Hospital Charge Code |
40206011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.83 |
| Max. Negotiated Rate |
$321.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$221.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$201.19
|
| Rate for Payer: Aetna Government |
$201.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$321.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$273.62
|
| Rate for Payer: Group Health Inc Commercial |
$201.19
|
| Rate for Payer: Group Health Inc Medicare |
$140.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.19
|
|
|
SYSTEM,KNEE ASF PS 13MM VEL3-5CD
|
Facility
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,700.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,955.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,570.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,210.00
|
|
|
SYSTEM,KNEE ASF PS 13MM VEL3-5CD
|
Facility
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007520
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
|
SYSTEM,KNEE ASF PS 14MM VEL6-9EF
|
Facility
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,700.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,955.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,570.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,210.00
|
|
|
SYSTEM,KNEE ASF PS 14MM VEL6-9EF
|
Facility
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
|
SYSTEM KNEE OFF ADPT TRI
|
Facility
OP
|
$4,250.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,463.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,337.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,125.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,444.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,463.16
|
| Rate for Payer: Group Health Inc Commercial |
$2,125.32
|
| Rate for Payer: Group Health Inc Medicare |
$1,487.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,762.91
|
|
|
SYSTEM KNEE OFF ADPT TRI
|
Facility
IP
|
$4,250.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907228
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.32 |
| Max. Negotiated Rate |
$2,125.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.32
|
|
|
SYSTEM, KNEE P 14MM 6-9 EF
|
Facility
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,462.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,337.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,125.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,443.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,462.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,125.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,487.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,762.50
|
|
|
SYSTEM, KNEE P 14MM 6-9 EF
|
Facility
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.00 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
|
|
SYSTEM, KNEE PERS 13MM VE
|
Facility
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,462.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,337.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,125.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,443.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,462.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,125.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,487.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,762.50
|
|
|
SYSTEM, KNEE PERS 13MM VE
|
Facility
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905516
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.00 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
|
|
SYSTEM MED GAS MGT
|
Facility
OP
|
$237.50
|
|
| Hospital Charge Code |
64907335
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.12 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$118.75
|
| Rate for Payer: Aetna Government |
$118.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.50
|
| Rate for Payer: Group Health Inc Commercial |
$118.75
|
| Rate for Payer: Group Health Inc Medicare |
$83.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.75
|
|
|
SYSTEM OXYGEN DELIVERY RED
|
Facility
OP
|
$38.75
|
|
| Hospital Charge Code |
64903065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.38
|
| Rate for Payer: Aetna Government |
$19.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.35
|
| Rate for Payer: Group Health Inc Commercial |
$19.38
|
| Rate for Payer: Group Health Inc Medicare |
$13.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.38
|
|
|
SYSTEM PERI 1.25 145 MC
|
Facility
OP
|
$8,487.50
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
64905319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,243.75 |
| Max. Negotiated Rate |
$20,278.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,668.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,243.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,880.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,243.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,516.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
|
|
SYSTEM PERI 1.25 145 MC
|
Facility
IP
|
$8,487.50
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
64905319
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,243.75 |
| Max. Negotiated Rate |
$4,243.75 |
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,243.75
|
|
|
SYSTEM PERI 1.25 145 SC
|
Facility
IP
|
$8,487.50
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
64905320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,243.75 |
| Max. Negotiated Rate |
$4,243.75 |
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,243.75
|
|
|
SYSTEM PERI 1.25 145 SC
|
Facility
OP
|
$8,487.50
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
64905320
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,243.75 |
| Max. Negotiated Rate |
$20,278.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,668.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,243.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,880.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,243.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,516.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
|
|
SYSTEM PERI 1.50 145
|
Facility
OP
|
$8,487.50
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
64905318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,243.75 |
| Max. Negotiated Rate |
$20,278.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,668.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,243.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,880.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,243.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,516.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
|
|
SYSTEM PERI 1.50 145
|
Facility
IP
|
$8,487.50
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
64905318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,243.75 |
| Max. Negotiated Rate |
$4,243.75 |
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,243.75
|
|
|
SYSTEM PERI 1.50 145 SC
|
Facility
OP
|
$8,487.50
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
64905321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,243.75 |
| Max. Negotiated Rate |
$20,278.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,668.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,243.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,880.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,243.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,516.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
|
|
SYSTEM PERI 1.50 145 SC
|
Facility
IP
|
$8,487.50
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
64905321
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,243.75 |
| Max. Negotiated Rate |
$4,243.75 |
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,243.75
|
|
|
SYSTEM PERI 2.00 145 SC
|
Facility
OP
|
$8,487.50
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
64905322
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,243.75 |
| Max. Negotiated Rate |
$20,278.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,668.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,243.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,880.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,243.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,516.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
|
