|
REP. SPRFCL WOUNDS 12.5 TO 20.0CM
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
30101153
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
REP. SPRFCL WOUNDS 12.5 TO 20.0CM
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 12005
|
| Hospital Charge Code |
30101153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$461.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
REP. UMB. HERNIA 5YRS OLD & OVER
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 49585
|
| Hospital Charge Code |
40011015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$526.11 |
| Max. Negotiated Rate |
$7,063.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,179.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$526.11
|
| Rate for Payer: Aetna Government |
$526.11
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,708.72
|
| Rate for Payer: Group Health Inc Medicare |
$3,296.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,708.72
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
REP. UMB. HERNIA INCARCERATED
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 49587
|
| Hospital Charge Code |
40019415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$563.26 |
| Max. Negotiated Rate |
$7,063.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,179.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$563.26
|
| Rate for Payer: Aetna Government |
$563.26
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,708.72
|
| Rate for Payer: Group Health Inc Medicare |
$3,296.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,708.72
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
REP. UMB. HERNIA UNDER 5 YRS. OLD
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 49580
|
| Hospital Charge Code |
40013184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$393.57 |
| Max. Negotiated Rate |
$7,063.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,179.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$393.57
|
| Rate for Payer: Aetna Government |
$393.57
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,708.72
|
| Rate for Payer: Group Health Inc Medicare |
$3,296.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,708.72
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
RESECT ENLARGED TOE
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28341
|
| Hospital Charge Code |
40024267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
RESECT ENLARGED TOE
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28341
|
| Hospital Charge Code |
40024267
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
RESECTION OF FACIAL TUMOR
|
Facility
|
IP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
40019889
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,285.96
|
|
|
RESECTION OF FACIAL TUMOR
|
Facility
|
OP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 21015
|
| Hospital Charge Code |
40019889
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$5,267.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,300.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,300.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,300.17
|
| Rate for Payer: Brighton Health Commercial |
$5,267.51
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| 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 |
$3,285.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,285.96
|
| Rate for Payer: Group Health Inc Medicare |
$3,285.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,793.07
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: Humana Medicare |
$3,351.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
RESECTION PSEUDO ANREURYSM
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
40031965
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$508.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.47
|
| Rate for Payer: Aetna Government |
$726.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.53
|
| Rate for Payer: Brighton Health Commercial |
$1,432.24
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$726.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.56
|
| Rate for Payer: Group Health Inc Commercial |
$726.47
|
| Rate for Payer: Group Health Inc Medicare |
$726.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.50
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: Humana Medicare |
$741.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.18
|
| Rate for Payer: Wellcare Medicare |
$690.15
|
|
|
RESECTION PSEUDO ANREURYSM
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
40031965
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$726.47
|
|
|
RESECTION SMALL BOWEL W ANASTAMOS
|
Facility
|
OP
|
$4,105.55
|
|
|
Service Code
|
HCPCS 44120
|
| Hospital Charge Code |
40019879
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,436.94 |
| Max. Negotiated Rate |
$3,079.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,258.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,452.94
|
| Rate for Payer: Aetna Government |
$1,452.94
|
| Rate for Payer: Brighton Health Commercial |
$3,079.16
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,052.78
|
| Rate for Payer: Group Health Inc Medicare |
$1,436.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,052.78
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
RESECTN ABDOMNL AORT ANURYSM
|
Facility
|
OP
|
$7,387.76
|
|
|
Service Code
|
HCPCS 35103
|
| Hospital Charge Code |
40031960
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$5,540.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,063.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,561.78
|
| Rate for Payer: Aetna Government |
$2,561.78
|
| Rate for Payer: Brighton Health Commercial |
$5,540.82
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,693.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,585.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,693.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,693.88
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
RESERVIOR
|
Facility
|
OP
|
$3,350.00
|
|
| Hospital Charge Code |
40203161
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,172.50 |
| Max. Negotiated Rate |
$2,680.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,842.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,675.00
|
| Rate for Payer: Aetna Government |
$1,675.00
|
| Rate for Payer: Brighton Health Commercial |
$2,512.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,680.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,278.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,675.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,172.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,675.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,675.00
|
|
|
RESERVIOR 65 ML (7240455)
|
Facility
|
OP
|
$5,505.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64904154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,926.75 |
| Max. Negotiated Rate |
$5,780.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,027.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Brighton Health Commercial |
$3,303.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,752.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,165.38
|
| Rate for Payer: EmblemHealth Commercial |
$2,752.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,780.25
|
| Rate for Payer: Group Health Inc Commercial |
$2,752.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,926.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,752.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,752.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,578.25
|
|
|
RESERVIOR 65 ML (7240455)
|
Facility
|
IP
|
$5,505.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64904154
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,752.50 |
| Max. Negotiated Rate |
$2,752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,752.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,752.50
|
|
|
RESERVIOR CL 125CC(ER8125)
|
Facility
|
OP
|
$4,985.00
|
|
| Hospital Charge Code |
64905527
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,744.75 |
| Max. Negotiated Rate |
$3,988.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,741.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,492.50
|
| Rate for Payer: Aetna Government |
$2,492.50
|
| Rate for Payer: Brighton Health Commercial |
$3,738.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,988.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,389.80
|
| Rate for Payer: Group Health Inc Commercial |
$2,492.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,744.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,492.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,492.50
|
|
|
RESERVIOR, CONCHA 1650ML
|
Facility
|
OP
|
$6.41
|
|
| Hospital Charge Code |
64901751
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.20
|
| Rate for Payer: Aetna Government |
$3.20
|
| Rate for Payer: Brighton Health Commercial |
$4.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.36
|
| Rate for Payer: Group Health Inc Commercial |
$3.20
|
| Rate for Payer: Group Health Inc Medicare |
$2.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.20
|
|
|
RESERVOIR 125CC, TITAN
|
Facility
|
IP
|
$5,707.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40203032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,853.75 |
| Max. Negotiated Rate |
$2,853.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,853.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,853.75
|
|
|
RESERVOIR 125CC, TITAN
|
Facility
|
OP
|
$5,707.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40203032
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,997.62 |
| Max. Negotiated Rate |
$5,992.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,139.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Brighton Health Commercial |
$3,424.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,853.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,281.81
|
| Rate for Payer: EmblemHealth Commercial |
$2,853.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,992.88
|
| Rate for Payer: Group Health Inc Commercial |
$2,853.75
|
| Rate for Payer: Group Health Inc Medicare |
$1,997.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,853.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,853.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,709.88
|
|
|
RESERVOIR, IZ, 100ML CONC
|
Facility
|
OP
|
$5,725.00
|
|
| Hospital Charge Code |
64906062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,003.75 |
| Max. Negotiated Rate |
$4,580.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,148.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,862.50
|
| Rate for Payer: Aetna Government |
$2,862.50
|
| Rate for Payer: Brighton Health Commercial |
$4,293.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,580.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,893.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,862.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,003.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,862.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,862.50
|
|
|
RESERVOIR,SILICONE,100CC,JAC
|
Facility
|
OP
|
$24.68
|
|
| Hospital Charge Code |
64902684
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$19.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.34
|
| Rate for Payer: Aetna Government |
$12.34
|
| Rate for Payer: Brighton Health Commercial |
$18.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.78
|
| Rate for Payer: Group Health Inc Commercial |
$12.34
|
| Rate for Payer: Group Health Inc Medicare |
$8.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.34
|
|
|
RESET DISLOCATED JAW
|
Facility
|
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
30103050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$190.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$190.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$190.90
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$272.71
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| 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 |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: Humana Medicare |
$278.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
RESET DISLOCATED JAW
|
Facility
|
IP
|
$653.13
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
30103050
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$272.71
|
|
|
RESIN-BASED COMP. 4 + PERM POST
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS D2394
|
| Hospital Charge Code |
42303282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$183.75
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
