|
WRAP VEST RAPR ROUND SM/MD
|
Facility
OP
|
$668.75
|
|
| Hospital Charge Code |
64903326
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$234.06 |
| Max. Negotiated Rate |
$535.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$367.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$334.38
|
| Rate for Payer: Aetna Government |
$334.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$535.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$454.75
|
| Rate for Payer: Group Health Inc Commercial |
$334.38
|
| Rate for Payer: Group Health Inc Medicare |
$234.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$334.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$334.38
|
|
|
WRENCH TORQUE 2MM
|
Facility
OP
|
$200.70
|
|
| Hospital Charge Code |
64906199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.24 |
| Max. Negotiated Rate |
$160.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.35
|
| Rate for Payer: Aetna Government |
$100.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.48
|
| Rate for Payer: Group Health Inc Commercial |
$100.35
|
| Rate for Payer: Group Health Inc Medicare |
$70.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.35
|
|
|
WRENDR KIT
|
Facility
OP
|
$90.00
|
|
| Hospital Charge Code |
40203006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.00
|
| Rate for Payer: Aetna Government |
$45.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.20
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
|
WRIGHT ANCHORLOCK LEADING EDGE SO
|
Facility
OP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$829.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$434.50
|
| 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 |
$395.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$454.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.50
|
| Rate for Payer: Group Health Inc Commercial |
$395.00
|
| Rate for Payer: Group Health Inc Medicare |
$276.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$513.50
|
|
|
WRIGHT ANCHORLOCK LEADING EDGE SO
|
Facility
OP
|
$790.00
|
|
| Hospital Charge Code |
40009338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$434.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$395.00
|
| Rate for Payer: Aetna Government |
$395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$632.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$537.20
|
| Rate for Payer: Group Health Inc Commercial |
$395.00
|
| Rate for Payer: Group Health Inc Medicare |
$276.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.00
|
|
|
WRIGHT ANCHORLOCK LEADING EDGE SO
|
Facility
IP
|
$790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$395.00 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.00
|
|
|
WRIGHT PELLETS OSTEOSET BONE FILL
|
Facility
OP
|
$1,310.00
|
|
| Hospital Charge Code |
40009339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.50 |
| Max. Negotiated Rate |
$1,048.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$720.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$655.00
|
| Rate for Payer: Aetna Government |
$655.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,048.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$890.80
|
| Rate for Payer: Group Health Inc Commercial |
$655.00
|
| Rate for Payer: Group Health Inc Medicare |
$458.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$655.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$655.00
|
|
|
WRIGHT PELLETS OSTEOSET BONE FILL
|
Facility
IP
|
$1,310.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.00 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$655.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$655.00
|
|
|
WRIGHT PELLETS OSTEOSET BONE FILL
|
Facility
OP
|
$1,310.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203356
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,375.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$720.50
|
| 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 |
$655.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$753.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,375.50
|
| Rate for Payer: Group Health Inc Commercial |
$655.00
|
| Rate for Payer: Group Health Inc Medicare |
$458.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$655.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$655.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$851.50
|
|
|
WRIGHT ROD TENDON
|
Facility
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,465.00 |
| Max. Negotiated Rate |
$2,465.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,465.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,465.00
|
|
|
WRIGHT ROD TENDON
|
Facility
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$5,176.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,711.50
|
| 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 |
$2,465.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,834.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,176.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,465.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,725.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,465.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,465.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,204.50
|
|
|
WRIGHT STAIN
|
Facility
OP
|
$10.68
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
40614100
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.27
|
| Rate for Payer: EmblemHealth Commercial |
$4.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.27
|
| Rate for Payer: Healthfirst QHP |
$4.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.42
|
| Rate for Payer: Wellcare Medicare |
$3.84
|
|
|
WRIST ENDOSCOPY W RELEASE OF LIGA
|
Facility
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 29848
|
| Hospital Charge Code |
40024269
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$581.54 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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: Elderplan Medicare Advantage |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$581.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| Rate for Payer: Group Health Inc Commercial |
$1,858.61
|
| Rate for Payer: Group Health Inc Medicare |
$1,858.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$646.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
Wrist Forearm Splint
|
Facility
OP
|
$48.55
|
|
| Hospital Charge Code |
40206950
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$38.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.28
|
| Rate for Payer: Aetna Government |
$24.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.01
|
| Rate for Payer: Group Health Inc Commercial |
$24.28
|
| Rate for Payer: Group Health Inc Medicare |
$16.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.28
|
|
|
WRISTJACK FRAC RED SYS TRAY
|
Facility
OP
|
$2,710.00
|
|
| Hospital Charge Code |
40202387
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$948.50 |
| Max. Negotiated Rate |
$2,168.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,490.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,355.00
|
| Rate for Payer: Aetna Government |
$1,355.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,842.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,355.00
|
| Rate for Payer: Group Health Inc Medicare |
$948.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,355.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,355.00
|
|
|
WRIST RESTRAINT
|
Facility
OP
|
$63.43
|
|
| Hospital Charge Code |
40206940
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.72
|
| Rate for Payer: Aetna Government |
$31.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.13
|
| Rate for Payer: Group Health Inc Commercial |
$31.72
|
| Rate for Payer: Group Health Inc Medicare |
$22.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.72
|
|
|
WRIST STRAPPING
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
30101324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$70.74
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
WS QLTD XXL ADULT BRIEFS 65-78
|
Facility
OP
|
$1.33
|
|
| Hospital Charge Code |
64902231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
| Rate for Payer: Aetna Government |
$0.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
|
|
WYDASE
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40206960
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
XC MINI ENDCAP, 15X12MM P 12
|
Facility
OP
|
$3,927.00
|
|
| Hospital Charge Code |
64905580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,374.45 |
| Max. Negotiated Rate |
$3,141.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,159.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,963.50
|
| Rate for Payer: Aetna Government |
$1,963.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,141.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,670.36
|
| Rate for Payer: Group Health Inc Commercial |
$1,963.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,374.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,963.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,963.50
|
|
|
X-CORE MINI CORE, 12MM 25-40MM
|
Facility
OP
|
$16,189.20
|
|
| Hospital Charge Code |
64905579
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$5,666.22 |
| Max. Negotiated Rate |
$12,951.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,904.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,094.60
|
| Rate for Payer: Aetna Government |
$8,094.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,951.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,008.66
|
| Rate for Payer: Group Health Inc Commercial |
$8,094.60
|
| Rate for Payer: Group Health Inc Medicare |
$5,666.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,094.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,094.60
|
|
|
XFUSE XLG 0 DEGREES
|
Facility
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.00 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,025.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,025.00
|
|
|
XFUSE XLG 0 DEGREES
|
Facility
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,152.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,127.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,025.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,178.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,152.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,025.00
|
| Rate for Payer: Group Health Inc Medicare |
$717.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,025.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,025.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,332.50
|
|
|
XGEVA 120MG - 1MG
|
Facility
IP
|
$28.15
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41655658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.08
|
|
|
XGEVA 120MG - 1MG
|
Facility
OP
|
$28.15
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
41655658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$26.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.20
|
| Rate for Payer: Aetna Government |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.20
|
| Rate for Payer: EmblemHealth Commercial |
$25.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.46
|
| Rate for Payer: Group Health Inc Commercial |
$25.20
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.42
|
| Rate for Payer: Healthfirst QHP |
$25.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.70
|
| Rate for Payer: SOMOS Essential |
$26.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.16
|
| Rate for Payer: Wellcare Medicare |
$23.94
|
|
