|
RETT SYNDROME MUTATION, N
|
Facility
|
OP
|
$1,319.68
|
|
|
Service Code
|
HCPCS 81302
|
| Hospital Charge Code |
30305430
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$369.51 |
| Max. Negotiated Rate |
$1,055.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$725.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$527.87
|
| Rate for Payer: Aetna Government |
$527.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$369.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$369.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$369.51
|
| Rate for Payer: Brighton Health Commercial |
$527.87
|
| Rate for Payer: Cash Price |
$527.87
|
| Rate for Payer: Cash Price |
$527.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$527.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,055.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$897.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$527.87
|
| Rate for Payer: EmblemHealth Commercial |
$527.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$448.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$469.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$527.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$469.80
|
| Rate for Payer: Group Health Inc Commercial |
$527.87
|
| Rate for Payer: Group Health Inc Medicare |
$527.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$659.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$527.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$527.87
|
| Rate for Payer: Healthfirst QHP |
$527.87
|
| Rate for Payer: Humana Medicare |
$538.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$527.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$527.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$527.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$422.30
|
| Rate for Payer: Wellcare Medicare |
$475.08
|
|
|
RETT SYNDROME MUTATION, N
|
Facility
|
IP
|
$1,319.68
|
|
|
Service Code
|
HCPCS 81302
|
| Hospital Charge Code |
30305430
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$527.87
|
|
|
REVERSE T3 SERUM
|
Facility
|
IP
|
$39.40
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
40609722
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$15.76
|
|
|
REVERSE T3 SERUM
|
Facility
|
OP
|
$39.40
|
|
|
Service Code
|
HCPCS 84482
|
| Hospital Charge Code |
40609722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$29.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.76
|
| Rate for Payer: Aetna Government |
$15.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.03
|
| Rate for Payer: Brighton Health Commercial |
$29.55
|
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Cash Price |
$15.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.76
|
| Rate for Payer: EmblemHealth Commercial |
$15.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| Rate for Payer: Group Health Inc Commercial |
$15.76
|
| Rate for Payer: Group Health Inc Medicare |
$15.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.76
|
| Rate for Payer: Healthfirst QHP |
$15.76
|
| Rate for Payer: Humana Medicare |
$16.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.76
|
| Rate for Payer: United Healthcare Commercial |
$19.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.61
|
| Rate for Payer: Wellcare Medicare |
$14.18
|
|
|
REVISE ARM/LEG NERVE
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64708
|
| Hospital Charge Code |
40009843
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,905.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$3,905.61
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
| Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
REVISE ARM/LEG NERVE
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64708
|
| Hospital Charge Code |
40009843
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
REVISE AV FISTULA-GRAFT
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36832
|
| Hospital Charge Code |
40034366
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
REVISE AV FISTULA-GRAFT
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36832
|
| Hospital Charge Code |
40034366
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$10,440.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,448.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,448.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,448.46
|
| Rate for Payer: Brighton Health Commercial |
$10,440.52
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$6,354.94
|
| Rate for Payer: Group Health Inc Medicare |
$6,354.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Humana Medicare |
$6,482.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
REVISE EYE MUSCLE
|
Facility
|
IP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67318
|
| Hospital Charge Code |
40074220
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,702.32
|
|
|
REVISE EYE MUSCLE
|
Facility
|
OP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67318
|
| Hospital Charge Code |
40074220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,395.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,702.32
|
| Rate for Payer: Aetna Government |
$2,702.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,891.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,891.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,891.62
|
| Rate for Payer: Brighton Health Commercial |
$4,395.92
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,702.32
|
| 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 |
$2,702.32
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,296.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,405.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,702.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,405.06
|
| Rate for Payer: Group Health Inc Commercial |
$2,702.32
|
| Rate for Payer: Group Health Inc Medicare |
$2,702.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,296.97
|
| Rate for Payer: Healthfirst QHP |
$2,702.32
|
| Rate for Payer: Humana Medicare |
$2,756.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,702.32
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,702.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,702.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,161.86
|
| Rate for Payer: Wellcare Medicare |
$2,567.20
|
|
|
REVISE EYE MUSCLES ADD-ON
|
Facility
|
OP
|
$758.15
|
|
|
Service Code
|
HCPCS 67332
|
| Hospital Charge Code |
40074164
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.35 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$392.61
|
| Rate for Payer: Aetna Government |
$392.61
|
| Rate for Payer: Brighton Health Commercial |
$568.61
|
| 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 |
$379.08
|
| Rate for Payer: Group Health Inc Medicare |
$265.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$379.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$379.08
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
REVISE EYE ONE HORIZONTAL MUSCLE
|
Facility
|
IP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67311
|
| Hospital Charge Code |
40074131
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,702.32
|
|
|
REVISE EYE ONE HORIZONTAL MUSCLE
|
Facility
|
OP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67311
|
| Hospital Charge Code |
40074131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,395.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,702.32
|
| Rate for Payer: Aetna Government |
$2,702.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,891.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,891.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,891.62
|
| Rate for Payer: Brighton Health Commercial |
$4,395.92
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,702.32
|
| 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 |
$2,702.32
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,296.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,405.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,702.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,405.06
|
| Rate for Payer: Group Health Inc Commercial |
$2,702.32
|
| Rate for Payer: Group Health Inc Medicare |
$2,702.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,296.97
|
| Rate for Payer: Healthfirst QHP |
$2,702.32
|
| Rate for Payer: Humana Medicare |
$2,756.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,702.32
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,702.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,702.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,161.86
|
| Rate for Payer: Wellcare Medicare |
$2,567.20
|
|
|
REVISE EYE ONE VERTICAL MUSCLE
|
Facility
|
IP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67314
|
| Hospital Charge Code |
40074132
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,702.32
|
|
|
REVISE EYE ONE VERTICAL MUSCLE
|
Facility
|
OP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67314
|
| Hospital Charge Code |
40074132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,395.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,702.32
|
| Rate for Payer: Aetna Government |
$2,702.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,891.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,891.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,891.62
|
| Rate for Payer: Brighton Health Commercial |
$4,395.92
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,702.32
|
| 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 |
$2,702.32
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,296.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,405.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,702.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,405.06
|
| Rate for Payer: Group Health Inc Commercial |
$2,702.32
|
| Rate for Payer: Group Health Inc Medicare |
$2,702.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,296.97
|
| Rate for Payer: Healthfirst QHP |
$2,702.32
|
| Rate for Payer: Humana Medicare |
$2,756.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,702.32
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,702.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,702.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,161.86
|
| Rate for Payer: Wellcare Medicare |
$2,567.20
|
|
|
REVISE FINGER JOINT
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26535
|
| Hospital Charge Code |
40029991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| 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 |
$2,683.00
|
| 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
|
|
|
REVISE FINGER JOINT
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26535
|
| Hospital Charge Code |
40029991
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
REVISE FINGER/TOE NERVE
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64702
|
| Hospital Charge Code |
40009440
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
REVISE FINGER/TOE NERVE
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64702
|
| Hospital Charge Code |
40009440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$3,905.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$3,905.61
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
| Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
IP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
40129466
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,031.47
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
40129466
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,856.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,822.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,822.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,822.03
|
| Rate for Payer: Brighton Health Commercial |
$6,856.80
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| 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 |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Humana Medicare |
$4,112.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
REVISE TWO HORIZONTAL EYE MUSCLES
|
Facility
|
OP
|
$9,471.08
|
|
|
Service Code
|
HCPCS 67312
|
| Hospital Charge Code |
40074133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,103.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,471.17
|
| Rate for Payer: Aetna Government |
$4,471.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,129.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,129.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,129.82
|
| Rate for Payer: Brighton Health Commercial |
$7,103.31
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,471.17
|
| 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 |
$4,471.17
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,800.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,979.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,471.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,979.34
|
| Rate for Payer: Group Health Inc Commercial |
$4,471.17
|
| Rate for Payer: Group Health Inc Medicare |
$4,471.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,735.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,471.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,800.49
|
| Rate for Payer: Healthfirst QHP |
$4,471.17
|
| Rate for Payer: Humana Medicare |
$4,560.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,471.17
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,471.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,471.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,576.94
|
| Rate for Payer: Wellcare Medicare |
$4,247.61
|
|
|
REVISE TWO HORIZONTAL EYE MUSCLES
|
Facility
|
IP
|
$9,471.08
|
|
|
Service Code
|
HCPCS 67312
|
| Hospital Charge Code |
40074133
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,471.17
|
|
|
REVISE TWO VERTICAL EYE MUSCLES
|
Facility
|
IP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67316
|
| Hospital Charge Code |
40079855
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,702.32
|
|
|
REVISE TWO VERTICAL EYE MUSCLES
|
Facility
|
OP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67316
|
| Hospital Charge Code |
40079855
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,395.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,702.32
|
| Rate for Payer: Aetna Government |
$2,702.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,891.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,891.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,891.62
|
| Rate for Payer: Brighton Health Commercial |
$4,395.92
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,702.32
|
| 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 |
$2,702.32
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,296.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,405.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,702.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,405.06
|
| Rate for Payer: Group Health Inc Commercial |
$2,702.32
|
| Rate for Payer: Group Health Inc Medicare |
$2,702.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,296.97
|
| Rate for Payer: Healthfirst QHP |
$2,702.32
|
| Rate for Payer: Humana Medicare |
$2,756.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,702.32
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,702.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,702.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,161.86
|
| Rate for Payer: Wellcare Medicare |
$2,567.20
|
|
