|
RESULTSEXPLAINED TO FAMILY
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 90887
|
| Hospital Charge Code |
30403101
|
|
Hospital Revenue Code
|
919
|
| 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
|
|
|
RESURF 12MM ART COMP 1.5MMX2.0MM
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,000.00
|
|
|
RESURF 12MM ART COMP 1.5MMX2.0MM
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,200.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,400.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,300.00
|
| Rate for Payer: EmblemHealth Commercial |
$2,000.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,200.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,000.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,600.00
|
|
|
RESURFACING 7.0MM TAPER POST
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
|
|
RESURFACING 7.0MM TAPER POST
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202221
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$480.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$460.00
|
| Rate for Payer: EmblemHealth Commercial |
$400.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$840.00
|
| Rate for Payer: Group Health Inc Commercial |
$400.00
|
| Rate for Payer: Group Health Inc Medicare |
$280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.00
|
|
|
RESUSCITATOR BAG, INFANT NEO
|
Facility
|
OP
|
$15.78
|
|
| Hospital Charge Code |
64902074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.89
|
| Rate for Payer: Aetna Government |
$7.89
|
| Rate for Payer: Brighton Health Commercial |
$11.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.73
|
| Rate for Payer: Group Health Inc Commercial |
$7.89
|
| Rate for Payer: Group Health Inc Medicare |
$5.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.89
|
|
|
RESUSCITATOR BAG, PEDI, TODD
|
Facility
|
OP
|
$19.25
|
|
| Hospital Charge Code |
64902073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$15.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.62
|
| Rate for Payer: Aetna Government |
$9.62
|
| Rate for Payer: Brighton Health Commercial |
$14.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.09
|
| Rate for Payer: Group Health Inc Commercial |
$9.62
|
| Rate for Payer: Group Health Inc Medicare |
$6.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.62
|
|
|
RETAINER-CAST METAL FOR ACID ETCH
|
Facility
|
OP
|
$362.50
|
|
|
Service Code
|
HCPCS D6545
|
| Hospital Charge Code |
42301515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.26 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.26
|
| Rate for Payer: Aetna Government |
$121.26
|
| Rate for Payer: Brighton Health Commercial |
$271.88
|
| 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: Group Health Inc Commercial |
$181.25
|
| Rate for Payer: Group Health Inc Medicare |
$126.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.25
|
|
|
RETAINER CROWN-3/4 TITANIUM & TIT
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D6784
|
| Hospital Charge Code |
42300724
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$199.37 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$199.37
|
| Rate for Payer: Aetna Government |
$199.37
|
| Rate for Payer: Brighton Health Commercial |
$750.00
|
| 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: Group Health Inc Commercial |
$500.00
|
| Rate for Payer: Group Health Inc Medicare |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
|
|
RETAINER CROWN-PORCELAIN FUSD TIT
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS D6753
|
| Hospital Charge Code |
42300723
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.35 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$687.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$241.35
|
| Rate for Payer: Aetna Government |
$241.35
|
| Rate for Payer: Brighton Health Commercial |
$937.50
|
| 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: Group Health Inc Commercial |
$625.00
|
| Rate for Payer: Group Health Inc Medicare |
$437.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.00
|
|
|
RETAINER CROWN-TITANIUM & TIT ALL
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS D6794
|
| Hospital Charge Code |
42300726
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$312.20 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$687.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$312.20
|
| Rate for Payer: Aetna Government |
$312.20
|
| Rate for Payer: Brighton Health Commercial |
$937.50
|
| 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: Group Health Inc Commercial |
$625.00
|
| Rate for Payer: Group Health Inc Medicare |
$437.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.00
|
|
|
RETAINER GLASSMAN MED. STERILE
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
40200471
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$210.00
|
| Rate for Payer: Aetna Government |
$210.00
|
| Rate for Payer: Brighton Health Commercial |
$315.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$336.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$285.60
|
| Rate for Payer: Group Health Inc Commercial |
$210.00
|
| Rate for Payer: Group Health Inc Medicare |
$147.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.00
|
|
|
RETAINER GLASSMAN MED.STERILE
|
Facility
|
OP
|
$86.26
|
|
| Hospital Charge Code |
64902792
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$69.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.13
|
| Rate for Payer: Aetna Government |
$43.13
|
| Rate for Payer: Brighton Health Commercial |
$64.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$69.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.66
|
| Rate for Payer: Group Health Inc Commercial |
$43.13
|
| Rate for Payer: Group Health Inc Medicare |
$30.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.13
|
|
|
RETAINER PORC RESIN BOND/FIXED
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS D6548
|
| Hospital Charge Code |
42303355
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$354.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$133.25
|
| Rate for Payer: Aetna Government |
$133.25
|
| Rate for Payer: Brighton Health Commercial |
$483.75
|
| 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: Group Health Inc Commercial |
$322.50
|
| Rate for Payer: Group Health Inc Medicare |
$225.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$322.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$322.50
|
|
|
RETICULIN AB IGA
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
40728081
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.05
|
|
|
RETICULIN AB IGA
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
40728081
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$15.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
RETICULIN IGA ANTIBODIES
|
Facility
|
IP
|
$30.13
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
40729753
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$12.05
|
|
|
RETICULIN IGA ANTIBODIES
|
Facility
|
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86255
|
| Hospital Charge Code |
40729753
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$22.60
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$15.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
RETICULOCYTE COUNT
|
Facility
|
OP
|
$5.93
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
40621552
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.37
|
| Rate for Payer: Aetna Government |
$2.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.66
|
| Rate for Payer: Brighton Health Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.37
|
| Rate for Payer: EmblemHealth Commercial |
$2.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.11
|
| Rate for Payer: Group Health Inc Commercial |
$2.37
|
| Rate for Payer: Group Health Inc Medicare |
$2.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.37
|
| Rate for Payer: Healthfirst QHP |
$2.37
|
| Rate for Payer: Humana Medicare |
$2.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare Commercial |
$3.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.90
|
| Rate for Payer: Wellcare Medicare |
$2.13
|
|
|
RETICULOCYTE COUNT
|
Facility
|
IP
|
$5.93
|
|
|
Service Code
|
HCPCS 85018
|
| Hospital Charge Code |
40621552
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$2.37
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$29,032.82
|
|
|
Service Code
|
MSDRG 815
|
| Min. Negotiated Rate |
$8,525.27 |
| Max. Negotiated Rate |
$29,032.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,659.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,114.78
|
| Rate for Payer: Aetna Government |
$21,114.78
|
| Rate for Payer: Brighton Health Commercial |
$14,415.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,537.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,168.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,168.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,059.04
|
| Rate for Payer: EmblemHealth Commercial |
$8,525.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,114.78
|
| Rate for Payer: Group Health Inc Commercial |
$21,114.78
|
| Rate for Payer: Group Health Inc Medicare |
$21,114.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,114.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,818.37
|
| Rate for Payer: Humana Medicare |
$29,032.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,114.78
|
| Rate for Payer: United Healthcare Commercial |
$19,771.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,114.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,114.78
|
| Rate for Payer: Wellcare Medicare |
$20,059.04
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$50,653.64
|
|
|
Service Code
|
MSDRG 814
|
| Min. Negotiated Rate |
$17,130.14 |
| Max. Negotiated Rate |
$50,653.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31,378.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,839.01
|
| Rate for Payer: Aetna Government |
$36,839.01
|
| Rate for Payer: Brighton Health Commercial |
$30,857.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,575.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36,750.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,327.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,997.06
|
| Rate for Payer: EmblemHealth Commercial |
$18,248.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,839.01
|
| Rate for Payer: Group Health Inc Commercial |
$36,839.01
|
| Rate for Payer: Group Health Inc Medicare |
$36,839.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,839.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,130.14
|
| Rate for Payer: Humana Medicare |
$50,653.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,839.01
|
| Rate for Payer: United Healthcare Commercial |
$42,321.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,839.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,839.01
|
| Rate for Payer: Wellcare Medicare |
$34,997.06
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$23,617.63
|
|
|
Service Code
|
MSDRG 816
|
| Min. Negotiated Rate |
$6,089.97 |
| Max. Negotiated Rate |
$23,617.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,176.46
|
| Rate for Payer: Aetna Government |
$17,176.46
|
| Rate for Payer: Brighton Health Commercial |
$10,297.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,519.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,264.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,121.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,317.64
|
| Rate for Payer: EmblemHealth Commercial |
$6,089.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,176.46
|
| Rate for Payer: Group Health Inc Commercial |
$17,176.46
|
| Rate for Payer: Group Health Inc Medicare |
$17,176.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,176.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,987.05
|
| Rate for Payer: Humana Medicare |
$23,617.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,176.46
|
| Rate for Payer: United Healthcare Commercial |
$14,123.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,176.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,176.46
|
| Rate for Payer: Wellcare Medicare |
$16,317.64
|
|
|
RETRACT ENDO FAN FNGR 10MM 36CM
|
Facility
|
OP
|
$1,337.42
|
|
| Hospital Charge Code |
40205970
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$468.10 |
| Max. Negotiated Rate |
$1,069.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$735.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$668.71
|
| Rate for Payer: Aetna Government |
$668.71
|
| Rate for Payer: Brighton Health Commercial |
$1,003.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,069.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$909.45
|
| Rate for Payer: Group Health Inc Commercial |
$668.71
|
| Rate for Payer: Group Health Inc Medicare |
$468.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$668.71
|
|
|
RETRACTION SYSTEM, DEEP SC SKW
|
Facility
|
OP
|
$913.90
|
|
| Hospital Charge Code |
64905122
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$319.86 |
| Max. Negotiated Rate |
$731.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$502.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$456.95
|
| Rate for Payer: Aetna Government |
$456.95
|
| Rate for Payer: Brighton Health Commercial |
$685.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$731.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$621.45
|
| Rate for Payer: Group Health Inc Commercial |
$456.95
|
| Rate for Payer: Group Health Inc Medicare |
$319.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.95
|
|
