|
TW DL/1.6X29MM 18MM
|
Facility
OP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$412.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$375.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$431.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$787.50
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$487.50
|
|
|
TW DL/1.6X29MM 18MM
|
Facility
IP
|
$750.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.00
|
|
|
TW DRILL W STOP
|
Facility
OP
|
$281.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.62 |
| Max. Negotiated Rate |
$295.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$154.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$140.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$162.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.87
|
| Rate for Payer: Group Health Inc Commercial |
$140.89
|
| Rate for Payer: Group Health Inc Medicare |
$98.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$183.16
|
|
|
TW DRILL W STOP
|
Facility
IP
|
$281.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904390
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.89 |
| Max. Negotiated Rate |
$140.89 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.89
|
|
|
TW DRL/1.6MM 5MM
|
Facility
OP
|
$242.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$254.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$121.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$139.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$254.47
|
| Rate for Payer: Group Health Inc Commercial |
$121.18
|
| Rate for Payer: Group Health Inc Medicare |
$84.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.53
|
|
|
TW DRL/1.6MM 5MM
|
Facility
OP
|
$193.88
|
|
| Hospital Charge Code |
40005861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.86 |
| Max. Negotiated Rate |
$155.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$106.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.94
|
| Rate for Payer: Aetna Government |
$96.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$131.84
|
| Rate for Payer: Group Health Inc Commercial |
$96.94
|
| Rate for Payer: Group Health Inc Medicare |
$67.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.94
|
|
|
TW DRL/1.6MM 5MM
|
Facility
IP
|
$242.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903289
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.18
|
|
|
TW DRL/1.6MM 7MM STRYKER
|
Facility
OP
|
$294.48
|
|
| Hospital Charge Code |
40005862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.07 |
| Max. Negotiated Rate |
$235.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$161.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.24
|
| Rate for Payer: Aetna Government |
$147.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$235.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$200.25
|
| Rate for Payer: Group Health Inc Commercial |
$147.24
|
| Rate for Payer: Group Health Inc Medicare |
$103.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.24
|
|
|
TWIST DRILL 1.1MM DIA X50MM CYLIN
|
Facility
OP
|
$248.00
|
|
| Hospital Charge Code |
40200844
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$198.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$124.00
|
| Rate for Payer: Aetna Government |
$124.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$198.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$168.64
|
| Rate for Payer: Group Health Inc Commercial |
$124.00
|
| Rate for Payer: Group Health Inc Medicare |
$86.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.00
|
|
|
TWIST DRILL 1.1MM DIAX50 W/NOTCH
|
Facility
OP
|
$224.00
|
|
| Hospital Charge Code |
40200845
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$179.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.00
|
| Rate for Payer: Aetna Government |
$112.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$179.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$152.32
|
| Rate for Payer: Group Health Inc Commercial |
$112.00
|
| Rate for Payer: Group Health Inc Medicare |
$78.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.00
|
|
|
TWIST DRILL2.2MM DIA X 70MM CYLIN
|
Facility
OP
|
$224.00
|
|
| Hospital Charge Code |
40200846
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$179.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.00
|
| Rate for Payer: Aetna Government |
$112.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$179.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$152.32
|
| Rate for Payer: Group Health Inc Commercial |
$112.00
|
| Rate for Payer: Group Health Inc Medicare |
$78.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.00
|
|
|
TWIST DRILL 2.2X 105
|
Facility
IP
|
$224.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.00
|
|
|
TWIST DRILL 2.2X 105
|
Facility
OP
|
$224.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$128.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$235.20
|
| Rate for Payer: Group Health Inc Commercial |
$112.00
|
| Rate for Payer: Group Health Inc Medicare |
$78.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$145.60
|
|
|
TWISTER PLS ROTBLE DEVICE 22MM
|
Facility
OP
|
$201.29
|
|
| Hospital Charge Code |
64905534
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.45 |
| Max. Negotiated Rate |
$161.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.64
|
| Rate for Payer: Aetna Government |
$100.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$161.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.88
|
| Rate for Payer: Group Health Inc Commercial |
$100.64
|
| Rate for Payer: Group Health Inc Medicare |
$70.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.64
|
|
|
TWISTER WIRE 7 BLUNT
|
Facility
OP
|
$402.50
|
|
| Hospital Charge Code |
64904652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.88 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$221.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$201.25
|
| Rate for Payer: Aetna Government |
$201.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$322.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$273.70
|
| Rate for Payer: Group Health Inc Commercial |
$201.25
|
| Rate for Payer: Group Health Inc Medicare |
$140.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.25
|
|
|
TWISTR PLS ROTABLE DEVICE 26MM
|
Facility
OP
|
$201.29
|
|
| Hospital Charge Code |
64905536
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.45 |
| Max. Negotiated Rate |
$161.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.64
|
| Rate for Payer: Aetna Government |
$100.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$161.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.88
|
| Rate for Payer: Group Health Inc Commercial |
$100.64
|
| Rate for Payer: Group Health Inc Medicare |
$70.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.64
|
|
|
TX CONTOUR DEFECTS 1.1 TO 5CC
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 11951
|
| Hospital Charge Code |
30307788
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| 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 |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
TX CONTOUR DEFECTS 1CC/<
|
Facility
OP
|
$507.72
|
|
|
Service Code
|
HCPCS 11950
|
| Hospital Charge Code |
30307888
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$253.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
TX,DX IV PUSH INT ARTERIAL INTIAL
|
Facility
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
40509878
|
|
Hospital Revenue Code
|
269
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$445.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$445.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$247.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| Rate for Payer: Group Health Inc Commercial |
$247.87
|
| Rate for Payer: Group Health Inc Medicare |
$247.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
TX FRACTURE FINGER/TOE/TRUNK
|
Facility
OP
|
$629.62
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
30105538
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$159.01
|
| 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 |
$314.81
|
| 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
|
|
|
TX FX ULNA W/MANIPULATION
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
30306516
|
|
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 |
$525.69
|
| 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 |
$584.10
|
| 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
|
|
|
TX GASTRO INTUB W/ASP
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 43753
|
| Hospital Charge Code |
40019720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| 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 |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
TX HAND DISLOCATION CL
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
30105370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$360.94
|
| 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
|
|
|
TX INCOMPLETE ABORTION ANY TRI
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
30106635
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$364.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| 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 |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
TX LOWER LEG TX
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
30306517
|
|
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 |
$351.01
|
| 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 |
$390.01
|
| 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
|
|
