|
Repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43761
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$200.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$200.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$200.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| 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 |
$285.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| Rate for Payer: Group Health Inc Commercial |
$285.81
|
| Rate for Payer: Group Health Inc Medicare |
$285.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.94
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: Humana Medicare |
$291.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
|
REPOSITION PACING-DEFIB LEAD
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
40039923
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
REPOSITION PACING-DEFIB LEAD
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 33215
|
| Hospital Charge Code |
40039923
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
REPROCESSED BUR ROUND FL 4MM
|
Facility
|
OP
|
$10.87
|
|
| Hospital Charge Code |
64905550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$8.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.44
|
| Rate for Payer: Aetna Government |
$5.44
|
| Rate for Payer: Brighton Health Commercial |
$8.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.39
|
| Rate for Payer: Group Health Inc Commercial |
$5.44
|
| Rate for Payer: Group Health Inc Medicare |
$3.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.44
|
|
|
REPROCESSED ENDOPATH W RATCH 5MM
|
Facility
|
OP
|
$10.83
|
|
| Hospital Charge Code |
64905435
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.42
|
| Rate for Payer: Aetna Government |
$5.42
|
| Rate for Payer: Brighton Health Commercial |
$8.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.36
|
| Rate for Payer: Group Health Inc Commercial |
$5.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.42
|
|
|
REPROCESSED MAX-P PEDIATRIC LIGHT
|
Facility
|
OP
|
$14.38
|
|
| Hospital Charge Code |
64905239
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.19
|
| Rate for Payer: Aetna Government |
$7.19
|
| Rate for Payer: Brighton Health Commercial |
$10.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.78
|
| Rate for Payer: Group Health Inc Commercial |
$7.19
|
| Rate for Payer: Group Health Inc Medicare |
$5.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.19
|
|
|
REPROCESSED SENSOR MAX-A ADULT
|
Facility
|
OP
|
$14.38
|
|
| Hospital Charge Code |
64905233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.19
|
| Rate for Payer: Aetna Government |
$7.19
|
| Rate for Payer: Brighton Health Commercial |
$10.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.78
|
| Rate for Payer: Group Health Inc Commercial |
$7.19
|
| Rate for Payer: Group Health Inc Medicare |
$5.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.19
|
|
|
REPROCESSED SENSOR MAX-I INFANT
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
64905237
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
|
|
REPROCESSED SENSOR NEO-NA AD
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
64905235
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
|
|
REPROCESSED STOCKING FLOWTRON
|
Facility
|
OP
|
$13.75
|
|
| Hospital Charge Code |
64905231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Brighton Health Commercial |
$10.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.35
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
|
|
REPROGRAM IMPLANT RECORDER
|
Facility
|
OP
|
$81.70
|
|
|
Service Code
|
HCPCS 93286 TC
|
| Hospital Charge Code |
30305070
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.97
|
| Rate for Payer: Aetna Government |
$10.97
|
| Rate for Payer: Brighton Health Commercial |
$61.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.56
|
| Rate for Payer: Group Health Inc Commercial |
$40.85
|
| Rate for Payer: Group Health Inc Medicare |
$28.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.85
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
REP SIMPLE F,E,E,N,MM 2.6 -5.0CM
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
42201630
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
REP SIMPLE F,E,E,N,MM 2.6 -5.0CM
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 12013
|
| Hospital Charge Code |
42201630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
REP SIMPLE F,M,MM 2.5
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
42201620
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
REP SIMPLE F,M,MM 2.5
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
42201620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
REP SIMPLE S,A,T,E 2.5
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
42201600
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
REP SIMPLE S,A,T,E 2.5
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
30103217
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
REP SIMPLE S,A,T,E 2.5
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
42201600
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
REP SIMPLE S,A,T,E 2.5
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 12001
|
| Hospital Charge Code |
30103217
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$231.52
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
REP SIMPLE S,A,T,E,2.6 - 7.5CM
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
42201610
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
REP SIMPLE S,A,T,E,2.6 - 7.5CM
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 12002
|
| Hospital Charge Code |
42201610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
REP SPICA, BODY CAST OR JACKET
|
Facility
|
IP
|
$405.08
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
30302028
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
REP SPICA, BODY CAST OR JACKET
|
Facility
|
IP
|
$405.08
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
40029001
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
REP SPICA, BODY CAST OR JACKET
|
Facility
|
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
30302028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.55
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| 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 |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Humana Medicare |
$185.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
REP SPICA, BODY CAST OR JACKET
|
Facility
|
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29720
|
| Hospital Charge Code |
40029001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.55
|
| Rate for Payer: Brighton Health Commercial |
$303.81
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$182.22
|
| Rate for Payer: Group Health Inc Medicare |
$182.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Humana Medicare |
$185.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
