|
SPLINT,FIBERGLASS,ORTHO,6X15
|
Facility
|
OP
|
$282.35
|
|
| Hospital Charge Code |
64902405
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.82 |
| Max. Negotiated Rate |
$225.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$155.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$141.18
|
| Rate for Payer: Aetna Government |
$141.18
|
| Rate for Payer: Brighton Health Commercial |
$211.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$225.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$192.00
|
| Rate for Payer: Group Health Inc Commercial |
$141.18
|
| Rate for Payer: Group Health Inc Medicare |
$98.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.18
|
|
|
SPLINT FINGER ASSORTMENT
|
Facility
|
OP
|
$5.96
|
|
| Hospital Charge Code |
64901566
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
| Rate for Payer: Aetna Government |
$2.98
|
| Rate for Payer: Brighton Health Commercial |
$4.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.05
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
|
|
SPLINT RESTING WIRE-FOAM RL
|
Facility
|
OP
|
$147.28
|
|
| Hospital Charge Code |
64903197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$117.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.64
|
| Rate for Payer: Aetna Government |
$73.64
|
| Rate for Payer: Brighton Health Commercial |
$110.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$117.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.15
|
| Rate for Payer: Group Health Inc Commercial |
$73.64
|
| Rate for Payer: Group Health Inc Medicare |
$51.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.64
|
|
|
SPLINT SEPTAL NEIMAN
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
40205969
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.00
|
| Rate for Payer: Aetna Government |
$36.00
|
| Rate for Payer: Brighton Health Commercial |
$54.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.96
|
| Rate for Payer: Group Health Inc Commercial |
$36.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.00
|
|
|
SPLINT SEPTAL NEIMAN
|
Facility
|
OP
|
$53.53
|
|
| Hospital Charge Code |
64903027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.76
|
| Rate for Payer: Aetna Government |
$26.76
|
| Rate for Payer: Brighton Health Commercial |
$40.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.40
|
| Rate for Payer: Group Health Inc Commercial |
$26.76
|
| Rate for Payer: Group Health Inc Medicare |
$18.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.76
|
|
|
SPLINT THERMA LARGE ENT
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
64904340
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.50
|
| Rate for Payer: Aetna Government |
$17.50
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.80
|
| Rate for Payer: Group Health Inc Commercial |
$17.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
|
Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)
|
Facility
|
OP
|
$4,148.81
|
|
|
Service Code
|
CPT 15120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$4,148.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 15100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SPLIT- THICK SG ARMS
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
40013141
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
SPLIT- THICK SG ARMS
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
40013141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,686.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Brighton Health Commercial |
$3,686.16
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SPLIT- THICK SG DIGITS
|
Facility
|
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013143
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,763.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Brighton Health Commercial |
$6,763.11
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
SPLIT- THICK SG DIGITS
|
Facility
|
IP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013143
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,148.81
|
|
|
SPLIT- THICK SG EARS
|
Facility
|
IP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013149
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,148.81
|
|
|
SPLIT- THICK SG EARS
|
Facility
|
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,763.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Brighton Health Commercial |
$6,763.11
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
SPLIT- THICK SG EYELIDS
|
Facility
|
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013146
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,763.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Brighton Health Commercial |
$6,763.11
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
SPLIT- THICK SG EYELIDS
|
Facility
|
IP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013146
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,148.81
|
|
|
SPLIT- THICK SG FACE
|
Facility
|
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013144
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,763.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Brighton Health Commercial |
$6,763.11
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
SPLIT- THICK SG FACE
|
Facility
|
IP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013144
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,148.81
|
|
|
SPLIT- THICK SG FEET
|
Facility
|
IP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013151
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,148.81
|
|
|
SPLIT- THICK SG FEET
|
Facility
|
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,763.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Brighton Health Commercial |
$6,763.11
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
SPLIT- THICK SG HANDS
|
Facility
|
IP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013150
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,148.81
|
|
|
SPLIT- THICK SG HANDS
|
Facility
|
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,763.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Brighton Health Commercial |
$6,763.11
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
|
SPLIT- THICK SG LEGS
|
Facility
|
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
40013140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,686.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Brighton Health Commercial |
$3,686.16
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SPLIT- THICK SG LEGS
|
Facility
|
IP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
40013140
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,108.87
|
|
|
SPLIT- THICK SG NECK
|
Facility
|
OP
|
$9,017.48
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
40013148
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,763.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,148.81
|
| Rate for Payer: Aetna Government |
$4,148.81
|
| Rate for Payer: Brighton Health Commercial |
$6,763.11
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Cash Price |
$4,148.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,148.81
|
| 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 |
$4,148.81
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,526.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,692.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,148.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,692.44
|
| Rate for Payer: Group Health Inc Commercial |
$4,148.81
|
| Rate for Payer: Group Health Inc Medicare |
$4,148.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,148.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,526.49
|
| Rate for Payer: Healthfirst QHP |
$4,148.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,148.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,148.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,319.05
|
| Rate for Payer: Wellcare Medicare |
$3,941.37
|
|
