|
SHO ARTHRS SRG LSS&RESCJ ADS
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29825
|
| Hospital Charge Code |
40029914
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| 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: Senior Whole Health 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
|
|
|
SHO ARTHRS SRG PRTL SYNVCT
|
Facility
|
IP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29820
|
| Hospital Charge Code |
40029427
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
SHO ARTHRS SRG PRTL SYNVCT
|
Facility
|
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29820
|
| Hospital Charge Code |
40029427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,588.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Brighton Health Commercial |
$13,588.37
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
SHO ARTHRS SRG RMVL LOOSE/FB
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29819
|
| Hospital Charge Code |
40023191
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
SHO ARTHRS SRG RMVL LOOSE/FB
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29819
|
| Hospital Charge Code |
40023191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| 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: Senior Whole Health 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
|
|
|
SHO ARTHRS SRG RT8TR CUF RPR
|
Facility
|
IP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
40024214
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
SHO ARTHRS SRG RT8TR CUF RPR
|
Facility
|
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
40024214
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,588.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Brighton Health Commercial |
$13,588.37
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
SHO ARTHRS SRG XTNSV DBRDMT
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
40024212
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
SHO ARTHRS SRG XTNSV DBRDMT
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
40024212
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| 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: Senior Whole Health 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
|
|
|
SHOE POST-OP MEN SMALL
|
Facility
|
OP
|
$13.75
|
|
| Hospital Charge Code |
64901248
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Brighton Health Commercial |
$10.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.35
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
|
|
SHOE,POST OP,SEMI R,MEN,LG
|
Facility
|
OP
|
$13.75
|
|
| Hospital Charge Code |
64901274
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Brighton Health Commercial |
$10.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.35
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
|
|
SHOE,POST OP,SEMI R,MEN,MD
|
Facility
|
OP
|
$13.75
|
|
| Hospital Charge Code |
64901211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Brighton Health Commercial |
$10.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.35
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
|
|
SHOE,POST OP,VINYL,H&L,M
|
Facility
|
OP
|
$8.85
|
|
| Hospital Charge Code |
64901774
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Brighton Health Commercial |
$6.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE,POST OP,VINYL,H&L,MEN
|
Facility
|
OP
|
$8.85
|
|
| Hospital Charge Code |
64901761
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Brighton Health Commercial |
$6.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE,POST OP,VINYL,MEN,SM
|
Facility
|
OP
|
$8.86
|
|
| Hospital Charge Code |
64901758
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.43
|
| Rate for Payer: Aetna Government |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$6.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.43
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.43
|
|
|
SHOE,POST OP,VINYL,WOMEN,LG
|
Facility
|
OP
|
$8.85
|
|
| Hospital Charge Code |
64901782
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Brighton Health Commercial |
$6.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE,POST OP,VINYL,WOMEN,MED
|
Facility
|
OP
|
$8.85
|
|
| Hospital Charge Code |
64901779
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Brighton Health Commercial |
$6.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE,POST OP,VINYL,WOMEN,SM
|
Facility
|
OP
|
$8.85
|
|
| Hospital Charge Code |
64901776
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Brighton Health Commercial |
$6.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE, ROCKER MED
|
Facility
|
OP
|
$4,158.00
|
|
| Hospital Charge Code |
64907389
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,455.30 |
| Max. Negotiated Rate |
$3,326.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,079.00
|
| Rate for Payer: Aetna Government |
$2,079.00
|
| Rate for Payer: Brighton Health Commercial |
$3,118.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,326.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,827.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,079.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,079.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,079.00
|
|
|
SHORT LEG CAST
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
30105936
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$310.57
|
|
|
SHORT LEG CAST
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
30305936
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$310.57
|
|
|
SHORT LEG CAST
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
30105936
|
|
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 |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$310.57
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| 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 |
$310.57
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| 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 |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$295.04
|
|
|
SHORT LEG CAST
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
30305936
|
|
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 |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$310.57
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| 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 |
$310.57
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| 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 |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$295.04
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC
|
Facility
|
IP
|
$35,676.16
|
|
|
Service Code
|
MSDRG 511
|
| Min. Negotiated Rate |
$16,264.13 |
| Max. Negotiated Rate |
$35,676.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,398.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,976.63
|
| Rate for Payer: Aetna Government |
$34,976.63
|
| Rate for Payer: Brighton Health Commercial |
$28,910.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,676.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,430.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,413.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,227.80
|
| Rate for Payer: EmblemHealth Commercial |
$17,096.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,976.63
|
| Rate for Payer: Group Health Inc Commercial |
$34,976.63
|
| Rate for Payer: Group Health Inc Medicare |
$34,976.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,976.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,264.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,976.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,976.63
|
| Rate for Payer: Wellcare Medicare |
$33,227.80
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC
|
Facility
|
IP
|
$46,982.04
|
|
|
Service Code
|
MSDRG 510
|
| Min. Negotiated Rate |
$20,950.79 |
| Max. Negotiated Rate |
$46,982.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40,115.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45,055.46
|
| Rate for Payer: Aetna Government |
$45,055.46
|
| Rate for Payer: Brighton Health Commercial |
$39,448.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45,956.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46,982.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38,771.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$42,802.69
|
| Rate for Payer: EmblemHealth Commercial |
$23,329.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$45,055.46
|
| Rate for Payer: Group Health Inc Commercial |
$45,055.46
|
| Rate for Payer: Group Health Inc Medicare |
$45,055.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45,055.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20,950.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45,055.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45,055.46
|
| Rate for Payer: Wellcare Medicare |
$42,802.69
|
|
