|
T001-IGE MAPLE/BOX ELDER
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
T003-IGE COMMON SILVER BIRCH
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729255
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
T007-IGE OAK, WHITE
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729260
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
T011-IGE MAPLE LEAF SYCAMORE
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729261
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
T2 ANKLE ARTHRO NAIL RT12MMX200MM
|
Facility
IP
|
$4,084.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,042.30 |
| Max. Negotiated Rate |
$2,042.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,042.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,042.30
|
|
|
T2 ANKLE ARTHRO NAIL RT12MMX200MM
|
Facility
OP
|
$4,084.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,288.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,246.53
|
| 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 |
$2,042.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,348.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,288.83
|
| Rate for Payer: Group Health Inc Commercial |
$2,042.30
|
| Rate for Payer: Group Health Inc Medicare |
$1,429.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,042.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,042.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,654.99
|
|
|
T2 ANKLE COMPRESSION SCREW
|
Facility
OP
|
$327.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$343.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$180.18
|
| 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 |
$163.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$188.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$343.98
|
| Rate for Payer: Group Health Inc Commercial |
$163.80
|
| Rate for Payer: Group Health Inc Medicare |
$114.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.94
|
|
|
T2 ANKLE COMPRESSION SCREW
|
Facility
IP
|
$327.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40005914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.80
|
|
|
T2 FEMORAL NAIL 11X 340MM
|
Facility
IP
|
$2,966.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,483.30 |
| Max. Negotiated Rate |
$1,483.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,483.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,483.30
|
|
|
T2 FEMORAL NAIL 11X 340MM
|
Facility
OP
|
$2,966.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,114.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,631.63
|
| 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 |
$1,483.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,705.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,114.93
|
| Rate for Payer: Group Health Inc Commercial |
$1,483.30
|
| Rate for Payer: Group Health Inc Medicare |
$1,038.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,483.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,483.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,928.29
|
|
|
T2 FEMUR 10X360MM
|
Facility
OP
|
$2,876.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,019.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,581.80
|
| 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 |
$1,438.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,653.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,019.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,438.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,006.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,438.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,438.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,869.40
|
|
|
T2 FEMUR 10X360MM
|
Facility
IP
|
$2,876.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.00 |
| Max. Negotiated Rate |
$1,438.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,438.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,438.00
|
|
|
T2 FEMUR 10X380MM FEMORALNAIL
|
Facility
OP
|
$238.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.90
|
| 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 |
$119.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$249.90
|
| Rate for Payer: Group Health Inc Commercial |
$119.00
|
| Rate for Payer: Group Health Inc Medicare |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.70
|
|
|
T2 FEMUR 10X380MM FEMORALNAIL
|
Facility
IP
|
$238.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.00
|
|
|
T2 HUMMERAL NAIL 9X27MM
|
Facility
IP
|
$1,230.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$615.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$615.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$615.25
|
|
|
T2 HUMMERAL NAIL 9X27MM
|
Facility
OP
|
$1,230.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200312
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,292.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$676.78
|
| 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 |
$615.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$707.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,292.02
|
| Rate for Payer: Group Health Inc Commercial |
$615.25
|
| Rate for Payer: Group Health Inc Medicare |
$430.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$615.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$615.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.82
|
|
|
T2 RECON 9X380MM
|
Facility
IP
|
$3,294.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,647.30 |
| Max. Negotiated Rate |
$1,647.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,647.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,647.30
|
|
|
T2 RECON 9X380MM
|
Facility
OP
|
$3,294.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200313
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,459.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,812.03
|
| 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 |
$1,647.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,894.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,459.33
|
| Rate for Payer: Group Health Inc Commercial |
$1,647.30
|
| Rate for Payer: Group Health Inc Medicare |
$1,153.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,647.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,647.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,141.49
|
|
|
T-3 (TRIIODOTHYRONINE) LEV RIA
|
Facility
OP
|
$35.45
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
40602355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.18
|
| Rate for Payer: Aetna Government |
$14.18
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.18
|
| Rate for Payer: EmblemHealth Commercial |
$14.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.62
|
| Rate for Payer: Group Health Inc Commercial |
$14.18
|
| Rate for Payer: Group Health Inc Medicare |
$14.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.18
|
| Rate for Payer: Healthfirst QHP |
$14.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.34
|
| Rate for Payer: Wellcare Medicare |
$12.76
|
|
|
T3 UPTAKE
|
Facility
OP
|
$16.18
|
|
|
Service Code
|
HCPCS 84479
|
| Hospital Charge Code |
40602340
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Cash Price |
$6.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
T4/T8 LYMPHO
|
Facility
OP
|
$94.33
|
|
|
Service Code
|
HCPCS 86359
|
| Hospital Charge Code |
40627582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.18 |
| Max. Negotiated Rate |
$59.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.73
|
| Rate for Payer: Aetna Government |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Cash Price |
$37.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$37.73
|
| Rate for Payer: EmblemHealth Commercial |
$37.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.58
|
| Rate for Payer: Group Health Inc Commercial |
$37.73
|
| Rate for Payer: Group Health Inc Medicare |
$37.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.73
|
| Rate for Payer: Healthfirst QHP |
$37.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.18
|
| Rate for Payer: Wellcare Medicare |
$33.96
|
|
|
T4 (THYROXINE) BY CPB
|
Facility
OP
|
$17.18
|
|
|
Service Code
|
HCPCS 84436
|
| Hospital Charge Code |
40602345
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$10.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.87
|
| Rate for Payer: Aetna Government |
$6.87
|
| Rate for Payer: Cash Price |
$6.87
|
| Rate for Payer: Cash Price |
$6.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.87
|
| Rate for Payer: EmblemHealth Commercial |
$6.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.11
|
| Rate for Payer: Group Health Inc Commercial |
$6.87
|
| Rate for Payer: Group Health Inc Medicare |
$6.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.87
|
| Rate for Payer: Healthfirst QHP |
$6.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.50
|
| Rate for Payer: Wellcare Medicare |
$6.18
|
|
|
TAC ABSORABLE FIXATION W/SPIKES
|
Facility
OP
|
$1,575.00
|
|
| Hospital Charge Code |
64902873
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$866.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$787.50
|
| Rate for Payer: Aetna Government |
$787.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,260.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,071.00
|
| Rate for Payer: Group Health Inc Commercial |
$787.50
|
| Rate for Payer: Group Health Inc Medicare |
$551.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$787.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$787.50
|
|
|
TAC ABSORABLE FIXATION W/SPIKES
|
Facility
OP
|
$492.66
|
|
| Hospital Charge Code |
40200713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.43 |
| Max. Negotiated Rate |
$394.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$270.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.33
|
| Rate for Payer: Aetna Government |
$246.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$394.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$335.01
|
| Rate for Payer: Group Health Inc Commercial |
$246.33
|
| Rate for Payer: Group Health Inc Medicare |
$172.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.33
|
|
|
TACROLIMUS 0.5 MG CAP
|
Facility
IP
|
$5.32
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
41644127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.66
|
|
