|
COMP TIB CRU RET SZ5 10MM
|
Facility
OP
|
$9,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64901476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$10,195.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,340.50
|
| 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 |
$4,855.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,583.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,195.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,855.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,398.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,855.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,855.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,311.50
|
|
|
COMP TIB CRU RET SZ5 10MM
|
Facility
IP
|
$9,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64901476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,855.00 |
| Max. Negotiated Rate |
$4,855.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,855.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,855.00
|
|
|
COMPUTERIZED CORNEAL TOPOGRAPHY
|
Facility
OP
|
$171.35
|
|
|
Service Code
|
HCPCS 92025
|
| Hospital Charge Code |
30302053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.92
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| 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
|
|
|
COMP VANGUARD FEMORAL CR
|
Facility
OP
|
$6,570.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$6,898.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,613.50
|
| 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 |
$3,285.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,777.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,898.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,285.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,299.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,285.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,270.50
|
|
|
COMP VANGUARD FEMORAL CR
|
Facility
IP
|
$6,570.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40204050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,285.00 |
| Max. Negotiated Rate |
$3,285.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,285.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.00
|
|
|
COMP VANGUARD TIB BEAR 12X7MM
|
Facility
IP
|
$2,298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.00 |
| Max. Negotiated Rate |
$1,149.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,149.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,149.00
|
|
|
COMP VANGUARD TIB BEAR 12X7MM
|
Facility
OP
|
$2,298.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,412.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,263.90
|
| 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 |
$1,149.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,321.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,412.90
|
| Rate for Payer: Group Health Inc Commercial |
$1,149.00
|
| Rate for Payer: Group Health Inc Medicare |
$804.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,149.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,149.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,493.70
|
|
|
CONCAVE REAMER -018
|
Facility
OP
|
$1,852.00
|
|
| Hospital Charge Code |
40005916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$648.20 |
| Max. Negotiated Rate |
$1,481.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,018.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$926.00
|
| Rate for Payer: Aetna Government |
$926.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,481.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,259.36
|
| Rate for Payer: Group Health Inc Commercial |
$926.00
|
| Rate for Payer: Group Health Inc Medicare |
$648.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$926.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$926.00
|
|
|
CONCAVE REAMER -020
|
Facility
OP
|
$1,852.00
|
|
| Hospital Charge Code |
40005917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$648.20 |
| Max. Negotiated Rate |
$1,481.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,018.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$926.00
|
| Rate for Payer: Aetna Government |
$926.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,481.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,259.36
|
| Rate for Payer: Group Health Inc Commercial |
$926.00
|
| Rate for Payer: Group Health Inc Medicare |
$648.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$926.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$926.00
|
|
|
CONCENTRATE ACID 1020
|
Facility
OP
|
$0.30
|
|
| Hospital Charge Code |
40209469
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
|
|
CONCENTRATE ACID R-145-4 2.5CA
|
Facility
OP
|
$9.29
|
|
| Hospital Charge Code |
64902303
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.64
|
| Rate for Payer: Aetna Government |
$4.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.32
|
| Rate for Payer: Group Health Inc Commercial |
$4.64
|
| Rate for Payer: Group Health Inc Medicare |
$3.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.64
|
|
|
CONCHA COLUMN SHELFPAK, PED
|
Facility
OP
|
$20.64
|
|
| Hospital Charge Code |
64901753
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Government |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.04
|
| Rate for Payer: Group Health Inc Commercial |
$10.32
|
| Rate for Payer: Group Health Inc Medicare |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
|
|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
IP
|
$185,999.22
|
|
|
Service Code
|
MS-DRG 212
|
| Min. Negotiated Rate |
$72,860.52 |
| Max. Negotiated Rate |
$185,999.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$158,813.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156,689.28
|
| Rate for Payer: Aetna Government |
$156,689.28
|
| Rate for Payer: Brighton Health Commercial |
$156,175.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$159,823.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$185,999.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$153,494.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$148,854.82
|
| Rate for Payer: EmblemHealth Commercial |
$92,358.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$156,689.28
|
| Rate for Payer: Group Health Inc Commercial |
$156,689.28
|
| Rate for Payer: Group Health Inc Medicare |
$156,689.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156,689.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72,860.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156,689.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156,689.28
|
| Rate for Payer: Wellcare Medicare |
$148,854.82
|
|
|
CONCURRENT IV INFUSION
|
Facility
OP
|
$71.45
|
|
|
Service Code
|
HCPCS 96368
|
| Hospital Charge Code |
40509895
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$57.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Government |
$18.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.33
|
| Rate for Payer: Group Health Inc Commercial |
$35.72
|
| Rate for Payer: Group Health Inc Medicare |
$25.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.70
|
|
|
CONCUSSION WITH CC
|
Facility
IP
|
$23,739.43
|
|
|
Service Code
|
MS-DRG 089
|
| Min. Negotiated Rate |
$9,860.39 |
| Max. Negotiated Rate |
$23,739.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,955.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,273.95
|
| Rate for Payer: Aetna Government |
$23,273.95
|
| Rate for Payer: Brighton Health Commercial |
$16,673.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,739.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,857.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,387.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,110.25
|
| Rate for Payer: EmblemHealth Commercial |
$9,860.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,273.95
|
| Rate for Payer: Group Health Inc Commercial |
$23,273.95
|
| Rate for Payer: Group Health Inc Medicare |
$23,273.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,273.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,822.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,273.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,273.95
|
| Rate for Payer: Wellcare Medicare |
$22,110.25
|
|
|
CONCUSSION WITH MCC
|
Facility
IP
|
$29,169.58
|
|
|
Service Code
|
MS-DRG 088
|
| Min. Negotiated Rate |
$13,152.30 |
| Max. Negotiated Rate |
$29,169.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,615.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,597.63
|
| Rate for Payer: Aetna Government |
$28,597.63
|
| Rate for Payer: Brighton Health Commercial |
$22,240.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,169.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,487.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,858.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,167.75
|
| Rate for Payer: EmblemHealth Commercial |
$13,152.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,597.63
|
| Rate for Payer: Group Health Inc Commercial |
$28,597.63
|
| Rate for Payer: Group Health Inc Medicare |
$28,597.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,597.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,297.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,597.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,597.63
|
| Rate for Payer: Wellcare Medicare |
$27,167.75
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
IP
|
$20,696.89
|
|
|
Service Code
|
MS-DRG 090
|
| Min. Negotiated Rate |
$8,015.91 |
| Max. Negotiated Rate |
$20,696.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,783.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,291.07
|
| Rate for Payer: Aetna Government |
$20,291.07
|
| Rate for Payer: Brighton Health Commercial |
$13,554.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,696.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,143.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,321.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,276.52
|
| Rate for Payer: EmblemHealth Commercial |
$8,015.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,291.07
|
| Rate for Payer: Group Health Inc Commercial |
$20,291.07
|
| Rate for Payer: Group Health Inc Medicare |
$20,291.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,291.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,435.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,291.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,291.07
|
| Rate for Payer: Wellcare Medicare |
$19,276.52
|
|
|
CONDITIONING PLAY AUDIOMETRY
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 92582
|
| Hospital Charge Code |
42004513
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$90.90 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
CONDUIT NERVE REPAIR 2.5MM ID
|
Facility
OP
|
$3,275.93
|
|
| Hospital Charge Code |
64904073
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,146.58 |
| Max. Negotiated Rate |
$2,620.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,801.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,637.96
|
| Rate for Payer: Aetna Government |
$1,637.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,620.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,227.63
|
| Rate for Payer: Group Health Inc Commercial |
$1,637.96
|
| Rate for Payer: Group Health Inc Medicare |
$1,146.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,637.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,637.96
|
|
|
CONDUIT NERVE REPAIR 3MM ID 2
|
Facility
OP
|
$3,845.55
|
|
| Hospital Charge Code |
64904372
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,345.94 |
| Max. Negotiated Rate |
$3,076.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,115.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,922.78
|
| Rate for Payer: Aetna Government |
$1,922.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,076.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,614.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,922.78
|
| Rate for Payer: Group Health Inc Medicare |
$1,345.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,922.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,922.78
|
|
|
CONDUIT NERVE REPAIR 4MM ID 2
|
Facility
OP
|
$3,845.55
|
|
| Hospital Charge Code |
64904080
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,345.94 |
| Max. Negotiated Rate |
$3,076.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,115.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,922.78
|
| Rate for Payer: Aetna Government |
$1,922.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,076.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,614.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,922.78
|
| Rate for Payer: Group Health Inc Medicare |
$1,345.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,922.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,922.78
|
|
|
CONDYLAR MARX TEMPORARY
|
Facility
OP
|
$2,155.30
|
|
| Hospital Charge Code |
64904448
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$754.36 |
| Max. Negotiated Rate |
$1,724.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,185.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,077.65
|
| Rate for Payer: Aetna Government |
$1,077.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,724.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,465.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,077.65
|
| Rate for Payer: Group Health Inc Medicare |
$754.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,077.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,077.65
|
|
|
CONDYLECTOMY
|
Facility
OP
|
$4,350.00
|
|
|
Service Code
|
HCPCS D7840
|
| Hospital Charge Code |
42301955
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,522.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,392.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,803.34
|
| Rate for Payer: Aetna Government |
$1,803.34
|
| 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: Group Health Inc Commercial |
$2,175.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,522.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,175.00
|
|
|
CONDYLE FASTENING SCREW
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| 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 |
$100.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.00
|
|
|
CONDYLE FASTENING SCREW
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200532
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
