|
CT THORAX DX C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 71270 TC
|
| Hospital Charge Code |
41201062
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$161.46 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.46
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.40
|
|
|
CT THORX DX C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 71260 TC
|
| Hospital Charge Code |
41208753
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$131.15 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.15
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.72
|
|
|
CT THORX DX C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Hospital Charge Code |
41208755
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.44 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.44
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.16
|
|
|
CT THORX DX C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 71270 TC
|
| Hospital Charge Code |
41208754
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$161.46 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.46
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.40
|
|
|
CT THRAX DX C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 71250 TC
|
| Hospital Charge Code |
41208752
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.44 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.44
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.16
|
|
|
CT TIBIAS/FIBULAS C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73701 TC
|
| Hospital Charge Code |
41207406
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$131.52 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.52
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.13
|
|
|
CT TIBIAS/FIBULAS C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73700 TC
|
| Hospital Charge Code |
41201128
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.81
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.57
|
|
|
CT TIBIAS/FIBULAS C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73702 TC
|
| Hospital Charge Code |
41207412
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$161.83 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.83
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.81
|
|
|
CT UPPER EXTREMITY C +
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
41202983
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$172.18 |
| Max. Negotiated Rate |
$925.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.26
|
| Rate for Payer: Aetna Government |
$578.26
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$925.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.18
|
| Rate for Payer: Group Health Inc Commercial |
$578.26
|
| Rate for Payer: Group Health Inc Medicare |
$404.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.31
|
|
|
CT UPPER EXTREMITY C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
41202982
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.51
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.46
|
|
|
CT UROGRAM
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74178 TC
|
| Hospital Charge Code |
41202980
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$290.10 |
| Max. Negotiated Rate |
$925.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.26
|
| Rate for Payer: Aetna Government |
$578.26
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$925.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$290.10
|
| Rate for Payer: Group Health Inc Commercial |
$578.26
|
| Rate for Payer: Group Health Inc Medicare |
$404.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.33
|
|
|
CT WRIST C+
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73201 TC
|
| Hospital Charge Code |
41207439
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$172.18 |
| Max. Negotiated Rate |
$925.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.26
|
| Rate for Payer: Aetna Government |
$578.26
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$925.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.18
|
| Rate for Payer: Group Health Inc Commercial |
$578.26
|
| Rate for Payer: Group Health Inc Medicare |
$404.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.31
|
|
|
CT WRIST C-
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 73200 TC
|
| Hospital Charge Code |
41207438
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.51
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.46
|
|
|
CT WRIST C-/C+
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 73202 TC
|
| Hospital Charge Code |
41207440
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.16 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.04
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$250.04
|
|
|
C TX PATELLAR DISLOCATION,WO ANES
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
40029100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$218.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| Rate for Payer: Group Health Inc Commercial |
$272.71
|
| Rate for Payer: Group Health Inc Medicare |
$272.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$439.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.80
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
C TX PATELLAR DISLOCAT. WO ANESTH
|
Facility
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
30103268
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$272.71
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| 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 |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
CUBE CNCLLS FRZ DRY 10MM 15CC
|
Facility
IP
|
$852.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$426.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$426.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$426.00
|
|
|
CUBE CNCLLS FRZ DRY 10MM 15CC
|
Facility
OP
|
$852.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$894.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$468.60
|
| 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 |
$426.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$489.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$894.60
|
| Rate for Payer: Group Health Inc Commercial |
$426.00
|
| Rate for Payer: Group Health Inc Medicare |
$298.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$426.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$426.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$553.80
|
|
|
CUBE EXTERNAL FIXATION RANCHO
|
Facility
IP
|
$587.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.56 |
| Max. Negotiated Rate |
$293.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.56
|
|
|
CUBE EXTERNAL FIXATION RANCHO
|
Facility
OP
|
$587.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$616.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$322.92
|
| 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 |
$293.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$337.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$616.49
|
| Rate for Payer: Group Health Inc Commercial |
$293.56
|
| Rate for Payer: Group Health Inc Medicare |
$205.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$381.63
|
|
|
CUBE RANCHO 4-HOLE ILIZAROV
|
Facility
IP
|
$681.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.72 |
| Max. Negotiated Rate |
$340.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.72
|
|
|
CUBE RANCHO 4-HOLE ILIZAROV
|
Facility
OP
|
$681.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$715.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$374.80
|
| 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 |
$340.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$391.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$715.52
|
| Rate for Payer: Group Health Inc Commercial |
$340.72
|
| Rate for Payer: Group Health Inc Medicare |
$238.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$442.94
|
|
|
CUBE RANCHO 5-HOLE S&N
|
Facility
OP
|
$752.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$790.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$413.97
|
| 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 |
$376.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$790.31
|
| Rate for Payer: Group Health Inc Commercial |
$376.34
|
| Rate for Payer: Group Health Inc Medicare |
$263.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$489.24
|
|
|
CUBE RANCHO 5-HOLE S&N
|
Facility
IP
|
$752.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$376.34 |
| Max. Negotiated Rate |
$376.34 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.34
|
|
|
CUBICIN PED 5MG/ML 500MG -PER 1MG
|
Facility
OP
|
$513.00
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
41647078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$282.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$256.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$294.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$256.50
|
| Rate for Payer: Group Health Inc Medicare |
$179.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$256.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$256.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.11
|
| Rate for Payer: SOMOS Essential |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$333.45
|
|
