|
TENDON ROD 5MMX24.5CM
|
Facility
OP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,599.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,361.80
|
| 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 |
$1,238.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,423.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,599.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,238.00
|
| Rate for Payer: Group Health Inc Medicare |
$866.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,238.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,238.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,609.40
|
|
|
TENDON ROD 5MMX24.5CM
|
Facility
IP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202078
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,238.00 |
| Max. Negotiated Rate |
$1,238.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,238.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,238.00
|
|
|
Tendon sheath incision (eg, for trigger finger)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$332.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| Rate for Payer: Group Health Inc Commercial |
$1,858.61
|
| Rate for Payer: Group Health Inc Medicare |
$1,858.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$368.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
TENDON TRANSFERS ARM
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 25310
|
| Hospital Charge Code |
40013178
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$706.95 |
| Max. Negotiated Rate |
$4,145.52 |
| 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: 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 CHP/HARP/Medicaid |
$706.95
|
| 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 CHP/FHP/Medicaid |
$785.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TENDON TRANSFERS ELBOW
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 24301
|
| Hospital Charge Code |
40013179
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$858.83 |
| Max. Negotiated Rate |
$9,058.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| 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 CHP/HARP/Medicaid |
$858.83
|
| 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 CHP/FHP/Medicaid |
$954.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TENDON TRANSFERS HAND
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26480
|
| Hospital Charge Code |
40013181
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$893.43 |
| Max. Negotiated Rate |
$4,145.52 |
| 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: 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 CHP/HARP/Medicaid |
$893.43
|
| 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 CHP/FHP/Medicaid |
$992.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TENDON TRANSFERS LEG
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26483
|
| Hospital Charge Code |
40013182
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$990.19 |
| Max. Negotiated Rate |
$4,145.52 |
| 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: 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 CHP/HARP/Medicaid |
$990.19
|
| 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 CHP/FHP/Medicaid |
$1,100.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TENDON TRANSFERS UPPER ARM
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 24301
|
| Hospital Charge Code |
40013180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$858.83 |
| Max. Negotiated Rate |
$9,058.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| 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 CHP/HARP/Medicaid |
$858.83
|
| 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 CHP/FHP/Medicaid |
$954.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TENDOR REPAIR ACHILLES
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 27650
|
| Hospital Charge Code |
40023202
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.38 |
| Max. Negotiated Rate |
$9,058.92 |
| 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: 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 CHP/HARP/Medicaid |
$733.38
|
| 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 CHP/FHP/Medicaid |
$814.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TENDOR REPAIR ACHILLES SECONDARY
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 27654
|
| Hospital Charge Code |
40029696
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$793.84 |
| Max. Negotiated Rate |
$9,058.92 |
| 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: 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 CHP/HARP/Medicaid |
$793.84
|
| 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 CHP/FHP/Medicaid |
$882.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TENDRIL 1688TC 46CM LEAD
|
Facility
OP
|
$1,200.00
|
|
| Hospital Charge Code |
40205170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$600.00
|
| Rate for Payer: Aetna Government |
$600.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$960.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$816.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|
|
TENDRIL 1788TC/52CM LEAD
|
Facility
OP
|
$1,200.00
|
|
| Hospital Charge Code |
40205169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$600.00
|
| Rate for Payer: Aetna Government |
$600.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$960.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$816.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|
|
TENDRIL 1888TC/58CM V LEAD
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
40205180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
|
|
TENDRIL 1888TC/58CM V LEAD
|
Facility
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1896
|
| Hospital Charge Code |
40205180
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$3,139.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,139.11
|
| Rate for Payer: Aetna Government |
$3,139.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,260.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$780.00
|
|
|
TENECTEPLASE 50 MG INJ
|
Facility
OP
|
$82.18
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
41654220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$162.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.11
|
| Rate for Payer: Aetna Government |
$153.11
|
| Rate for Payer: Cash Price |
$153.11
|
| Rate for Payer: Cash Price |
$153.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$153.11
|
| Rate for Payer: EmblemHealth Commercial |
$153.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$153.11
|
| Rate for Payer: Group Health Inc Medicare |
$153.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.15
|
| Rate for Payer: Healthfirst QHP |
$153.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.30
|
| Rate for Payer: SOMOS Essential |
$162.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$122.49
|
| Rate for Payer: Wellcare Medicare |
$145.46
|
|
|
TENECTEPLASE 50 MG INJ
|
Facility
OP
|
$82.18
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
41644220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$162.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.11
|
| Rate for Payer: Aetna Government |
$153.11
|
| Rate for Payer: Cash Price |
$153.11
|
| Rate for Payer: Cash Price |
$153.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$153.11
|
| Rate for Payer: EmblemHealth Commercial |
$153.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$153.11
|
| Rate for Payer: Group Health Inc Medicare |
$153.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.15
|
| Rate for Payer: Healthfirst QHP |
$153.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.30
|
| Rate for Payer: SOMOS Essential |
$162.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$122.49
|
| Rate for Payer: Wellcare Medicare |
$145.46
|
|
|
TENECTEPLASE 50 MG INJ
|
Facility
IP
|
$82.18
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
41654220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Cash Price |
$153.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.09
|
|
|
TENECTEPLASE 50 MG INJ
|
Facility
IP
|
$82.18
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
41644220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Cash Price |
$153.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.09
|
|
|
TENIVAC ADULT INJ 5-2 LF UNITS
|
Facility
IP
|
$36.84
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41646086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.42 |
| Max. Negotiated Rate |
$18.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.42
|
|
|
TENIVAC ADULT INJ 5-2 LF UNITS
|
Facility
OP
|
$36.84
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41656086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.22
|
| Rate for Payer: Aetna Government |
$26.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.94
|
| Rate for Payer: Group Health Inc Commercial |
$18.42
|
| Rate for Payer: Group Health Inc Medicare |
$12.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.96
|
| Rate for Payer: SOMOS Essential |
$19.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.95
|
|
|
TENIVAC ADULT INJ 5-2 LF UNITS
|
Facility
IP
|
$36.84
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41656086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.42 |
| Max. Negotiated Rate |
$18.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.42
|
|
|
TENIVAC ADULT INJ 5-2 LF UNITS
|
Facility
OP
|
$36.84
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41646086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.22
|
| Rate for Payer: Aetna Government |
$26.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.94
|
| Rate for Payer: Group Health Inc Commercial |
$18.42
|
| Rate for Payer: Group Health Inc Medicare |
$12.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.96
|
| Rate for Payer: SOMOS Essential |
$19.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.95
|
|
|
Tenodesis of long tendon of biceps
|
Facility
OP
|
$8,273.12
|
|
|
Service Code
|
CPT 23430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.17 |
| Max. Negotiated Rate |
$8,273.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$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 CHP/HARP/Medicaid |
$846.17
|
| 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 Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$940.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TENOFOVIR 300 MG TAB
|
Facility
OP
|
$48.08
|
|
| Hospital Charge Code |
41652728
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$38.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.04
|
| Rate for Payer: Aetna Government |
$24.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.69
|
| Rate for Payer: Group Health Inc Commercial |
$24.04
|
| Rate for Payer: Group Health Inc Medicare |
$16.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.25
|
|
|
TENOFOVIR 300 MG TAB
|
Facility
OP
|
$48.08
|
|
| Hospital Charge Code |
41642728
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$38.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.04
|
| Rate for Payer: Aetna Government |
$24.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.69
|
| Rate for Payer: Group Health Inc Commercial |
$24.04
|
| Rate for Payer: Group Health Inc Medicare |
$16.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.25
|
|
