|
TRAY,LUMBAR PUNCTURE,20X3.5
|
Facility
OP
|
$20.63
|
|
| Hospital Charge Code |
64901740
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Government |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.03
|
| Rate for Payer: Group Health Inc Commercial |
$10.32
|
| Rate for Payer: Group Health Inc Medicare |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
|
|
TRAY MAMMOTOME CONFIRM MCTRAY
|
Facility
OP
|
$11.14
|
|
| Hospital Charge Code |
41301570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.57
|
| Rate for Payer: Aetna Government |
$5.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.58
|
| Rate for Payer: Group Health Inc Commercial |
$5.57
|
| Rate for Payer: Group Health Inc Medicare |
$3.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.57
|
|
|
TRAY,METER,16 FR,LATEX FREE
|
Facility
OP
|
$24.58
|
|
| Hospital Charge Code |
64901625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.29
|
| Rate for Payer: Aetna Government |
$12.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.71
|
| Rate for Payer: Group Health Inc Commercial |
$12.29
|
| Rate for Payer: Group Health Inc Medicare |
$8.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.29
|
|
|
TRAY,METER,18 FR LATEX FREE
|
Facility
OP
|
$24.58
|
|
| Hospital Charge Code |
64901629
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.29
|
| Rate for Payer: Aetna Government |
$12.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.71
|
| Rate for Payer: Group Health Inc Commercial |
$12.29
|
| Rate for Payer: Group Health Inc Medicare |
$8.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.29
|
|
|
TRAY,METER,200ML,CATHETER,ALL S
|
Facility
OP
|
$27.80
|
|
| Hospital Charge Code |
64901997
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.90
|
| Rate for Payer: Aetna Government |
$13.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.90
|
| Rate for Payer: Group Health Inc Commercial |
$13.90
|
| Rate for Payer: Group Health Inc Medicare |
$9.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.90
|
|
|
TRAY REUSABLE STERILIZATION
|
Facility
OP
|
$750.00
|
|
| Hospital Charge Code |
64907104
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$412.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$375.00
|
| Rate for Payer: Aetna Government |
$375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$510.00
|
| Rate for Payer: Group Health Inc Commercial |
$375.00
|
| Rate for Payer: Group Health Inc Medicare |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.00
|
|
|
TRAY SINGLE LUMEN 2FR 28CM STYLET
|
Facility
OP
|
$55.43
|
|
| Hospital Charge Code |
64902443
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$44.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.72
|
| Rate for Payer: Aetna Government |
$27.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.69
|
| Rate for Payer: Group Health Inc Commercial |
$27.72
|
| Rate for Payer: Group Health Inc Medicare |
$19.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.72
|
|
|
TRAY SKIN PREP DRY W/BASIN
|
Facility
OP
|
$7.89
|
|
| Hospital Charge Code |
64901930
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$6.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.94
|
| Rate for Payer: Aetna Government |
$3.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.37
|
| Rate for Payer: Group Health Inc Commercial |
$3.94
|
| Rate for Payer: Group Health Inc Medicare |
$2.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.94
|
|
|
TRAY SPINAL ANES W/TETRACAINE
|
Facility
OP
|
$31.26
|
|
| Hospital Charge Code |
64901872
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$25.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.63
|
| Rate for Payer: Aetna Government |
$15.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.26
|
| Rate for Payer: Group Health Inc Commercial |
$15.63
|
| Rate for Payer: Group Health Inc Medicare |
$10.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.63
|
|
|
TRAY SPINAL/EPIDURAL COMBINED
|
Facility
OP
|
$115.00
|
|
| Hospital Charge Code |
64902773
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.50
|
| Rate for Payer: Aetna Government |
$57.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Group Health Inc Commercial |
$57.50
|
| Rate for Payer: Group Health Inc Medicare |
$40.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.50
|
|
|
TRAY SUBCLAVIAN INSERTION
|
Facility
OP
|
$202.62
|
|
| Hospital Charge Code |
40209481
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.92 |
| Max. Negotiated Rate |
$162.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$111.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$101.31
|
| Rate for Payer: Aetna Government |
$101.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$162.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$137.78
|
| Rate for Payer: Group Health Inc Commercial |
$101.31
|
| Rate for Payer: Group Health Inc Medicare |
$70.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.31
|
|
|
TRAY, SUTURE REMOVAL
|
Facility
OP
|
$285.00
|
|
| Hospital Charge Code |
64906020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$142.50
|
| Rate for Payer: Aetna Government |
$142.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$228.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$193.80
|
| Rate for Payer: Group Health Inc Commercial |
$142.50
|
| Rate for Payer: Group Health Inc Medicare |
$99.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.50
|
|
|
TRAY,THORACENTESIS,DRAINAGE
|
Facility
OP
|
$179.83
|
|
| Hospital Charge Code |
64901183
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.94 |
| Max. Negotiated Rate |
$143.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$98.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$89.92
|
| Rate for Payer: Aetna Government |
$89.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$143.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.28
|
| Rate for Payer: Group Health Inc Commercial |
$89.92
|
| Rate for Payer: Group Health Inc Medicare |
$62.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.92
|
|
|
TRAY TIB MED
|
Facility
OP
|
$5,535.00
|
|
| Hospital Charge Code |
64907422
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,937.25 |
| Max. Negotiated Rate |
$4,428.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,044.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,767.50
|
| Rate for Payer: Aetna Government |
$2,767.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,428.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,763.80
|
| Rate for Payer: Group Health Inc Commercial |
$2,767.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,937.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,767.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,767.50
|
|
|
TRAY TRACHEOSTOMY CARE W/2 4X4'S
|
Facility
OP
|
$3.69
|
|
| Hospital Charge Code |
64901685
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.84
|
| Rate for Payer: Aetna Government |
$1.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.51
|
| Rate for Payer: Group Health Inc Commercial |
$1.84
|
| Rate for Payer: Group Health Inc Medicare |
$1.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.84
|
|
|
TRAY URETHRAL CATH 14FR 75000
|
Facility
OP
|
$5.99
|
|
| Hospital Charge Code |
64901662
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.07
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
|
|
TRAY URINE METER 18FR TEMP SENSOR
|
Facility
OP
|
$39.54
|
|
| Hospital Charge Code |
64903276
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$31.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.77
|
| Rate for Payer: Aetna Government |
$19.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.89
|
| Rate for Payer: Group Health Inc Commercial |
$19.77
|
| Rate for Payer: Group Health Inc Medicare |
$13.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.77
|
|
|
TRAY WAYNE PNEUMOTHORAX A
|
Facility
OP
|
$470.67
|
|
| Hospital Charge Code |
64901529
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$164.73 |
| Max. Negotiated Rate |
$376.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$235.34
|
| Rate for Payer: Aetna Government |
$235.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$376.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$320.06
|
| Rate for Payer: Group Health Inc Commercial |
$235.34
|
| Rate for Payer: Group Health Inc Medicare |
$164.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.34
|
|
|
TRAZODONE 100 MG TAB
|
Facility
OP
|
$0.13
|
|
| Hospital Charge Code |
41641070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
TRAZODONE 100 MG TAB
|
Facility
OP
|
$0.13
|
|
| Hospital Charge Code |
41651070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
TRAZODONE SERUM
|
Facility
OP
|
$44.40
|
|
|
Service Code
|
HCPCS 80338
|
| Hospital Charge Code |
40609727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.19
|
| Rate for Payer: Group Health Inc Commercial |
$22.20
|
| Rate for Payer: Group Health Inc Medicare |
$15.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.20
|
|
|
TRB @ GENE REARRANGE AMPLIFY
|
Facility
OP
|
$522.30
|
|
|
Service Code
|
HCPCS 81340
|
| Hospital Charge Code |
30305427
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$167.14 |
| Max. Negotiated Rate |
$417.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$287.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$208.92
|
| Rate for Payer: Aetna Government |
$208.92
|
| Rate for Payer: Brighton Health Commercial |
$208.92
|
| Rate for Payer: Cash Price |
$208.92
|
| Rate for Payer: Cash Price |
$208.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$417.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$355.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$208.92
|
| Rate for Payer: EmblemHealth Commercial |
$208.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.94
|
| Rate for Payer: Group Health Inc Commercial |
$208.92
|
| Rate for Payer: Group Health Inc Medicare |
$208.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.92
|
| Rate for Payer: Healthfirst QHP |
$208.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$167.14
|
| Rate for Payer: Wellcare Medicare |
$188.03
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
40024353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$218.17 |
| 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: 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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$445.95
|
| 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 |
$272.71
|
| Rate for Payer: Group Health Inc Medicare |
$272.71
|
| 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 |
$495.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.80
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 27840
|
| Hospital Charge Code |
30103029
|
|
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: 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 CHP/HARP/Medicaid |
$445.95
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health 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
|
|
|
TREAT ANKLE FRACTURE W/MANIP
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
30306674
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.17 |
| 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: Brighton Health Commercial |
$233.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$443.46
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$492.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.80
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| 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: 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
|
|
