|
RESPIRATORY SYNCYTIAL AG IF
|
Facility
|
OP
|
$33.55
|
|
|
Service Code
|
HCPCS 87280
|
| Hospital Charge Code |
40613064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.42
|
| Rate for Payer: Aetna Government |
$13.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.39
|
| Rate for Payer: Brighton Health Commercial |
$25.16
|
| Rate for Payer: Cash Price |
$13.42
|
| Rate for Payer: Cash Price |
$13.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.42
|
| Rate for Payer: EmblemHealth Commercial |
$13.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.94
|
| Rate for Payer: Group Health Inc Commercial |
$13.42
|
| Rate for Payer: Group Health Inc Medicare |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.42
|
| Rate for Payer: Healthfirst QHP |
$13.42
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.74
|
| Rate for Payer: Wellcare Medicare |
$12.08
|
|
|
RESPIRATORY SYNCYTIAL VIRUS
|
Facility
|
OP
|
$34.78
|
|
|
Service Code
|
HCPCS 87420
|
| Hospital Charge Code |
40614106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.91
|
| Rate for Payer: Aetna Government |
$13.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.74
|
| Rate for Payer: Brighton Health Commercial |
$26.08
|
| Rate for Payer: Cash Price |
$13.91
|
| Rate for Payer: Cash Price |
$13.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.91
|
| Rate for Payer: EmblemHealth Commercial |
$13.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.38
|
| Rate for Payer: Group Health Inc Commercial |
$13.91
|
| Rate for Payer: Group Health Inc Medicare |
$13.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.91
|
| Rate for Payer: Healthfirst QHP |
$13.91
|
| Rate for Payer: Humana Medicare |
$14.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.91
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.13
|
| Rate for Payer: Wellcare Medicare |
$12.52
|
|
|
RESPIRATORY SYNCYTIAL VIRUS
|
Facility
|
IP
|
$34.78
|
|
|
Service Code
|
HCPCS 87420
|
| Hospital Charge Code |
40614106
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$13.91
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$61,630.90
|
|
|
Service Code
|
MSDRG 208
|
| Min. Negotiated Rate |
$20,842.45 |
| Max. Negotiated Rate |
$61,630.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39,867.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44,822.47
|
| Rate for Payer: Aetna Government |
$44,822.47
|
| Rate for Payer: Brighton Health Commercial |
$39,205.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45,718.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46,691.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38,532.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$42,581.35
|
| Rate for Payer: EmblemHealth Commercial |
$23,185.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$44,822.47
|
| Rate for Payer: Group Health Inc Commercial |
$44,822.47
|
| Rate for Payer: Group Health Inc Medicare |
$44,822.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44,822.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20,842.45
|
| Rate for Payer: Humana Medicare |
$61,630.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44,822.47
|
| Rate for Payer: United Healthcare Commercial |
$53,770.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44,822.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44,822.47
|
| Rate for Payer: Wellcare Medicare |
$42,581.35
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$141,795.13
|
|
|
Service Code
|
MSDRG 207
|
| Min. Negotiated Rate |
$47,952.53 |
| Max. Negotiated Rate |
$141,795.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101,858.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103,123.73
|
| Rate for Payer: Aetna Government |
$103,123.73
|
| Rate for Payer: Brighton Health Commercial |
$100,166.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105,186.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119,294.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98,446.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$97,967.54
|
| Rate for Payer: EmblemHealth Commercial |
$59,236.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$103,123.73
|
| Rate for Payer: Group Health Inc Commercial |
$103,123.73
|
| Rate for Payer: Group Health Inc Medicare |
$103,123.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103,123.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47,952.53
|
| Rate for Payer: Humana Medicare |
$141,795.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103,123.73
|
| Rate for Payer: United Healthcare Commercial |
$137,379.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103,123.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103,123.73
|
| Rate for Payer: Wellcare Medicare |
$97,967.54
|
|
|
RESP MOT MGMT SIMUL ADD-ON CODE
|
Facility
|
OP
|
$81.19
|
|
|
Service Code
|
HCPCS 77293
|
| Hospital Charge Code |
66542930
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$601.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$601.00
|
| Rate for Payer: Aetna Government |
$601.00
|
| Rate for Payer: Brighton Health Commercial |
$60.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$40.60
|
| Rate for Payer: Group Health Inc Medicare |
$28.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.60
|
|
|
RESP MOT MGMT SIMUL ADD-ON CODE
|
Facility
|
OP
|
$2,332.70
|
|
|
Service Code
|
HCPCS 77293 TC
|
| Hospital Charge Code |
66542998
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,866.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,282.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$472.78
|
| Rate for Payer: Aetna Government |
$472.78
|
| Rate for Payer: Brighton Health Commercial |
$1,749.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,866.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,586.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,166.35
|
| Rate for Payer: Group Health Inc Medicare |
$816.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.35
|
|
|
REST DS STM MD
|
Facility
|
OP
|
$11,128.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$11,684.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,120.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$6,676.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,564.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,398.67
|
| Rate for Payer: EmblemHealth Commercial |
$5,564.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,684.53
|
| Rate for Payer: Group Health Inc Commercial |
$5,564.06
|
| Rate for Payer: Group Health Inc Medicare |
$3,894.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,564.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,564.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,233.28
|
|
|
REST DS STM MD
|
Facility
|
IP
|
$11,128.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,564.06 |
| Max. Negotiated Rate |
$5,564.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,564.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,564.06
|
|
|
REST MD CLCR BODY
|
Facility
|
OP
|
$16,196.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$17,006.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,907.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$9,717.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,098.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,312.84
|
| Rate for Payer: EmblemHealth Commercial |
$8,098.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,006.06
|
| Rate for Payer: Group Health Inc Commercial |
$8,098.12
|
| Rate for Payer: Group Health Inc Medicare |
$5,668.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,098.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,098.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10,527.56
|
|
|
REST MD CLCR BODY
|
Facility
|
IP
|
$16,196.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907296
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,098.12 |
| Max. Negotiated Rate |
$8,098.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,098.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,098.12
|
|
|
RESTORATION MODULAR HIP SYS 19MM
|
Facility
|
IP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,500.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,500.00
|
|
|
RESTORATION MODULAR HIP SYS 19MM
|
Facility
|
OP
|
$9,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$9,450.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,950.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$5,400.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,175.00
|
| Rate for Payer: EmblemHealth Commercial |
$4,500.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,450.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,500.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,500.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,850.00
|
|
|
RESTORATION MODULAR HIP SYS 25MM
|
Facility
|
IP
|
$11,702.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,851.00 |
| Max. Negotiated Rate |
$5,851.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,851.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,851.00
|
|
|
RESTORATION MODULAR HIP SYS 25MM
|
Facility
|
OP
|
$11,702.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205020
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$12,287.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,436.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$7,021.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,851.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,728.65
|
| Rate for Payer: EmblemHealth Commercial |
$5,851.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,287.10
|
| Rate for Payer: Group Health Inc Commercial |
$5,851.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,095.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,851.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,851.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,606.30
|
|
|
RESTOR MODR HIP SYSTEM 15MMX14MM
|
Facility
|
OP
|
$9,001.60
|
|
| Hospital Charge Code |
40009104
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3,150.56 |
| Max. Negotiated Rate |
$7,201.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,950.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,500.80
|
| Rate for Payer: Aetna Government |
$4,500.80
|
| Rate for Payer: Brighton Health Commercial |
$6,751.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,201.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,121.09
|
| Rate for Payer: Group Health Inc Commercial |
$4,500.80
|
| Rate for Payer: Group Health Inc Medicare |
$3,150.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,500.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,500.80
|
|
|
RESTOR MODR HIP SYSTEM 19MM
|
Facility
|
OP
|
$9,001.60
|
|
| Hospital Charge Code |
40009105
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3,150.56 |
| Max. Negotiated Rate |
$7,201.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,950.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,500.80
|
| Rate for Payer: Aetna Government |
$4,500.80
|
| Rate for Payer: Brighton Health Commercial |
$6,751.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,201.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,121.09
|
| Rate for Payer: Group Health Inc Commercial |
$4,500.80
|
| Rate for Payer: Group Health Inc Medicare |
$3,150.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,500.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,500.80
|
|
|
REST PRX CN BD MOD
|
Facility
|
IP
|
$15,532.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,766.25 |
| Max. Negotiated Rate |
$7,766.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,766.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,766.25
|
|
|
REST PRX CN BD MOD
|
Facility
|
OP
|
$15,532.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$16,309.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,542.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$9,319.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,766.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,931.19
|
| Rate for Payer: EmblemHealth Commercial |
$7,766.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,309.12
|
| Rate for Payer: Group Health Inc Commercial |
$7,766.25
|
| Rate for Payer: Group Health Inc Medicare |
$5,436.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,766.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,766.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10,096.12
|
|
|
RESTRICTOR CEMENT 18.5
|
Facility
|
OP
|
$1,417.50
|
|
| Hospital Charge Code |
64902735
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$496.12 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$779.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$708.75
|
| Rate for Payer: Aetna Government |
$708.75
|
| Rate for Payer: Brighton Health Commercial |
$1,063.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,134.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$963.90
|
| Rate for Payer: Group Health Inc Commercial |
$708.75
|
| Rate for Payer: Group Health Inc Medicare |
$496.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$708.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.75
|
|
|
RESTRICTOR OMNIFIT CEMENT
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$108.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.50
|
| Rate for Payer: EmblemHealth Commercial |
$90.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.00
|
| Rate for Payer: Group Health Inc Commercial |
$90.00
|
| Rate for Payer: Group Health Inc Medicare |
$63.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.00
|
|
|
RESTRICTOR OMNIFIT CEMENT
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
|
|
RESTRICTOR UNIV CMNT
|
Facility
|
IP
|
$407.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.88 |
| Max. Negotiated Rate |
$203.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.88
|
|
|
RESTRICTOR UNIV CMNT
|
Facility
|
OP
|
$407.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907294
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$428.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$244.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$203.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.46
|
| Rate for Payer: EmblemHealth Commercial |
$203.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$428.14
|
| Rate for Payer: Group Health Inc Commercial |
$203.88
|
| Rate for Payer: Group Health Inc Medicare |
$142.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.04
|
|
|
RESULTS EXPLAINED TO FAM.
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 90887
|
| Hospital Charge Code |
30400099
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.80
|
| Rate for Payer: Aetna Government |
$64.80
|
| Rate for Payer: Brighton Health Commercial |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
|
