|
CITALOPRAM 20 MG TAB
|
Facility
OP
|
$0.03
|
|
| Hospital Charge Code |
41644071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
CITALOPRAM 20 MG TAB
|
Facility
OP
|
$0.03
|
|
| Hospital Charge Code |
41654071
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
CITALOPRAM 40 MG TAB
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
41644072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.88
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.40
|
|
|
CITALOPRAM 40 MG TAB
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
41654072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.88
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.40
|
|
|
CITRIC ACID (CITRATE), URINE
|
Facility
OP
|
$69.50
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
40609053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.80
|
| Rate for Payer: Aetna Government |
$27.80
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.80
|
| Rate for Payer: EmblemHealth Commercial |
$27.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.74
|
| Rate for Payer: Group Health Inc Commercial |
$27.80
|
| Rate for Payer: Group Health Inc Medicare |
$27.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.80
|
| Rate for Payer: Healthfirst QHP |
$27.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.24
|
| Rate for Payer: Wellcare Medicare |
$25.02
|
|
|
CK-ISOENZYME ELECTROPHORESIS
|
Facility
OP
|
$33.48
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
40607420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$21.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.39
|
| Rate for Payer: Aetna Government |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.39
|
| Rate for Payer: EmblemHealth Commercial |
$13.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.92
|
| Rate for Payer: Group Health Inc Commercial |
$13.39
|
| Rate for Payer: Group Health Inc Medicare |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.39
|
| Rate for Payer: Healthfirst QHP |
$13.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.71
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
|
|
CKMB.
|
Facility
OP
|
$28.88
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
40602646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$18.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.55
|
| Rate for Payer: Aetna Government |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.55
|
| Rate for Payer: EmblemHealth Commercial |
$11.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.28
|
| Rate for Payer: Group Health Inc Commercial |
$11.55
|
| Rate for Payer: Group Health Inc Medicare |
$11.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.55
|
| Rate for Payer: Healthfirst QHP |
$11.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.24
|
| Rate for Payer: Wellcare Medicare |
$10.40
|
|
|
CK, TOTAL+ISOENZYMES,SERUM
|
Facility
OP
|
$16.28
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
40609058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$10.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.51
|
| Rate for Payer: Aetna Government |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.51
|
| Rate for Payer: EmblemHealth Commercial |
$6.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$6.51
|
| Rate for Payer: Group Health Inc Medicare |
$6.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.51
|
| Rate for Payer: Healthfirst QHP |
$6.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.21
|
| Rate for Payer: Wellcare Medicare |
$5.86
|
|
|
CLADRIBINE 10MG/10ML INJECTION
|
Facility
OP
|
$38.58
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
41647831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$25.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.77
|
| Rate for Payer: Aetna Government |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.56
|
| Rate for Payer: Group Health Inc Commercial |
$15.77
|
| Rate for Payer: Group Health Inc Medicare |
$15.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.41
|
| Rate for Payer: Healthfirst QHP |
$15.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.59
|
| Rate for Payer: SOMOS Essential |
$17.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.62
|
| Rate for Payer: Wellcare Medicare |
$14.98
|
|
|
CLADRIBINE 10MG/10ML INJECTION
|
Facility
IP
|
$38.58
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
41657831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$19.29 |
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.29
|
|
|
CLADRIBINE 10MG/10ML INJECTION
|
Facility
OP
|
$38.58
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
41657831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$25.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.77
|
| Rate for Payer: Aetna Government |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.56
|
| Rate for Payer: Group Health Inc Commercial |
$15.77
|
| Rate for Payer: Group Health Inc Medicare |
$15.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.41
|
| Rate for Payer: Healthfirst QHP |
$15.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.59
|
| Rate for Payer: SOMOS Essential |
$17.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.62
|
| Rate for Payer: Wellcare Medicare |
$14.98
|
|
|
CLADRIBINE 10MG/10ML INJECTION
|
Facility
IP
|
$38.58
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
41647831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$19.29 |
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.29
|
|
|
CLAMP
|
Facility
OP
|
$538.00
|
|
| Hospital Charge Code |
40202168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$188.30 |
| Max. Negotiated Rate |
$430.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$295.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$269.00
|
| Rate for Payer: Aetna Government |
$269.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$430.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$365.84
|
| Rate for Payer: Group Health Inc Commercial |
$269.00
|
| Rate for Payer: Group Health Inc Medicare |
$188.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$269.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$269.00
|
|
|
CLAMP
|
Facility
OP
|
$994.50
|
|
| Hospital Charge Code |
64904057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$348.08 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$546.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$497.25
|
| Rate for Payer: Aetna Government |
$497.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$795.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$676.26
|
| Rate for Payer: Group Health Inc Commercial |
$497.25
|
| Rate for Payer: Group Health Inc Medicare |
$348.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$497.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$497.25
|
|
|
CLAMP 10 HOLE
|
Facility
OP
|
$1,460.00
|
|
| Hospital Charge Code |
64905945
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$511.00 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$803.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$730.00
|
| Rate for Payer: Aetna Government |
$730.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$992.80
|
| Rate for Payer: Group Health Inc Commercial |
$730.00
|
| Rate for Payer: Group Health Inc Medicare |
$511.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$730.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$730.00
|
|
|
CLAMP 4.0MM ADJUSTABLE MR SAFE
|
Facility
OP
|
$1,442.00
|
|
| Hospital Charge Code |
40200190
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$504.70 |
| Max. Negotiated Rate |
$1,153.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$793.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$721.00
|
| Rate for Payer: Aetna Government |
$721.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,153.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$980.56
|
| Rate for Payer: Group Health Inc Commercial |
$721.00
|
| Rate for Payer: Group Health Inc Medicare |
$504.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$721.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$721.00
|
|
|
CLAMP 5 HOLE
|
Facility
OP
|
$848.40
|
|
| Hospital Charge Code |
40202169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$678.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$466.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$424.20
|
| Rate for Payer: Aetna Government |
$424.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$678.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$576.91
|
| Rate for Payer: Group Health Inc Commercial |
$424.20
|
| Rate for Payer: Group Health Inc Medicare |
$296.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$424.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$424.20
|
|
|
CLAMP ADJUSTABLE SYNTHES
|
Facility
OP
|
$640.00
|
|
| Hospital Charge Code |
40200191
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$352.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$320.00
|
| Rate for Payer: Aetna Government |
$320.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$512.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$435.20
|
| Rate for Payer: Group Health Inc Commercial |
$320.00
|
| Rate for Payer: Group Health Inc Medicare |
$224.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.00
|
|
|
CLAMP COMBINATION LG MR SAFE
|
Facility
OP
|
$1,232.00
|
|
| Hospital Charge Code |
40200192
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$431.20 |
| Max. Negotiated Rate |
$985.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$677.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$616.00
|
| Rate for Payer: Aetna Government |
$616.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$985.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$837.76
|
| Rate for Payer: Group Health Inc Commercial |
$616.00
|
| Rate for Payer: Group Health Inc Medicare |
$431.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$616.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$616.00
|
|
|
CLAMP,DELTA 3, HOFFMAN
|
Facility
OP
|
$2,130.00
|
|
| Hospital Charge Code |
64905540
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,171.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,065.00
|
| Rate for Payer: Aetna Government |
$1,065.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,704.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,448.40
|
| Rate for Payer: Group Health Inc Commercial |
$1,065.00
|
| Rate for Payer: Group Health Inc Medicare |
$745.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,065.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,065.00
|
|
|
CLAMP EXTERNAL FIXATION 11M
|
Facility
OP
|
$2,076.13
|
|
| Hospital Charge Code |
64905538
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$726.65 |
| Max. Negotiated Rate |
$1,660.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,141.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,038.06
|
| Rate for Payer: Aetna Government |
$1,038.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,660.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,411.77
|
| Rate for Payer: Group Health Inc Commercial |
$1,038.06
|
| Rate for Payer: Group Health Inc Medicare |
$726.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.06
|
|
|
CLAMP EXTERNAL FIXATION 30M
|
Facility
OP
|
$2,335.50
|
|
| Hospital Charge Code |
64905562
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$817.42 |
| Max. Negotiated Rate |
$1,868.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,284.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,167.75
|
| Rate for Payer: Aetna Government |
$1,167.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,868.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,588.14
|
| Rate for Payer: Group Health Inc Commercial |
$1,167.75
|
| Rate for Payer: Group Health Inc Medicare |
$817.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,167.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,167.75
|
|
|
CLAMP EXTERNAL FIXATION 4.5
|
Facility
OP
|
$973.38
|
|
| Hospital Charge Code |
64904526
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$340.68 |
| Max. Negotiated Rate |
$778.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$535.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$486.69
|
| Rate for Payer: Aetna Government |
$486.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$778.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$661.90
|
| Rate for Payer: Group Health Inc Commercial |
$486.69
|
| Rate for Payer: Group Health Inc Medicare |
$340.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$486.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$486.69
|
|
|
CLAMP EXTERNAL FIXATION MUL
|
Facility
OP
|
$1,460.00
|
|
| Hospital Charge Code |
64904518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$511.00 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$803.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$730.00
|
| Rate for Payer: Aetna Government |
$730.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$992.80
|
| Rate for Payer: Group Health Inc Commercial |
$730.00
|
| Rate for Payer: Group Health Inc Medicare |
$511.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$730.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$730.00
|
|
|
CLAMP EXTERNAL FIXATION REP A
|
Facility
OP
|
$1,095.00
|
|
| Hospital Charge Code |
64904516
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$383.25 |
| Max. Negotiated Rate |
$876.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$602.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$547.50
|
| Rate for Payer: Aetna Government |
$547.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$876.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$744.60
|
| Rate for Payer: Group Health Inc Commercial |
$547.50
|
| Rate for Payer: Group Health Inc Medicare |
$383.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$547.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$547.50
|
|
