|
DISTAL SPACER 12MM
|
Facility
IP
|
$450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
|
|
DISTAL SPACER 12MM
|
Facility
OP
|
$450.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| 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 |
$225.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$258.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$472.50
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
|
DISTILLED WATER 1000CC
|
Facility
OP
|
$9.22
|
|
| Hospital Charge Code |
40505000
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.61
|
| Rate for Payer: Aetna Government |
$4.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.27
|
| Rate for Payer: Group Health Inc Commercial |
$4.61
|
| Rate for Payer: Group Health Inc Medicare |
$3.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.61
|
|
|
DISTILLED WATER 250CC
|
Facility
OP
|
$6.73
|
|
| Hospital Charge Code |
40505002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
|
DISTILLED WATER 500 CC
|
Facility
OP
|
$7.44
|
|
| Hospital Charge Code |
40505001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.72
|
| Rate for Payer: Aetna Government |
$3.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.06
|
| Rate for Payer: Group Health Inc Commercial |
$3.72
|
| Rate for Payer: Group Health Inc Medicare |
$2.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.72
|
|
|
DIST NEURO PERIPH NERVE
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64640
|
| Hospital Charge Code |
30305728
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.30 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
DISTRACTOR M/T TRIAX DYN TB
|
Facility
OP
|
$4,598.75
|
|
| Hospital Charge Code |
64904095
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,609.56 |
| Max. Negotiated Rate |
$3,679.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,529.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,299.38
|
| Rate for Payer: Aetna Government |
$2,299.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,679.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,127.15
|
| Rate for Payer: Group Health Inc Commercial |
$2,299.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,609.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,299.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,299.38
|
|
|
DIST WEDGE 15MM SZ6
|
Facility
OP
|
$3,900.00
|
|
| Hospital Charge Code |
64903972
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,145.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,950.00
|
| Rate for Payer: Aetna Government |
$1,950.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,120.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,652.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,950.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,365.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,950.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,950.00
|
|
|
DIVALPROEX 125 MG SPRINKLES DRC
|
Facility
OP
|
$0.97
|
|
| Hospital Charge Code |
41651240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.49
|
| Rate for Payer: Aetna Government |
$0.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
DIVALPROEX 125 MG SPRINKLES DRC
|
Facility
OP
|
$0.97
|
|
| Hospital Charge Code |
41641240
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.49
|
| Rate for Payer: Aetna Government |
$0.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
DIVALPROEX 250MG DR TAB
|
Facility
OP
|
$0.03
|
|
| Hospital Charge Code |
41657997
|
|
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
|
|
|
DIVALPROEX 250MG DR TAB
|
Facility
OP
|
$0.03
|
|
| Hospital Charge Code |
41647997
|
|
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
|
|
|
DIVALPROEX 250 MG ERT
|
Facility
OP
|
$0.52
|
|
| Hospital Charge Code |
41643118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
DIVALPROEX 250 MG ERT
|
Facility
OP
|
$0.52
|
|
| Hospital Charge Code |
41653118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
DIVALPROEX 500MG DR TAB
|
Facility
OP
|
$0.18
|
|
| Hospital Charge Code |
41647995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
DIVALPROEX 500MG DR TAB
|
Facility
OP
|
$0.18
|
|
| Hospital Charge Code |
41657995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
DIVALPROEX 500 MG ERT
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41643119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DIVALPROEX 500 MG ERT
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41653119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
DIVISION OF FALLOPIAN TUBE
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58600
|
| Hospital Charge Code |
40054170
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.80 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$463.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
DJD BODY
|
Facility
OP
|
$5,710.60
|
|
| Hospital Charge Code |
40200856
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,998.71 |
| Max. Negotiated Rate |
$4,568.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,140.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,855.30
|
| Rate for Payer: Aetna Government |
$2,855.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,568.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,883.21
|
| Rate for Payer: Group Health Inc Commercial |
$2,855.30
|
| Rate for Payer: Group Health Inc Medicare |
$1,998.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,855.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,855.30
|
|
|
DJD CLAMP
|
Facility
OP
|
$8,206.25
|
|
| Hospital Charge Code |
64905802
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,872.19 |
| Max. Negotiated Rate |
$6,565.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,513.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,103.12
|
| Rate for Payer: Aetna Government |
$4,103.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,565.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,580.25
|
| Rate for Payer: Group Health Inc Commercial |
$4,103.12
|
| Rate for Payer: Group Health Inc Medicare |
$2,872.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,103.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,103.12
|
|
|
DMNDBK 360 1.25 MCR CRX145CM OAS
|
Facility
OP
|
$10,790.00
|
|
| Hospital Charge Code |
40005128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,776.50 |
| Max. Negotiated Rate |
$8,632.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,934.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,395.00
|
| Rate for Payer: Aetna Government |
$5,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,632.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,337.20
|
| Rate for Payer: Group Health Inc Commercial |
$5,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,776.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,395.00
|
|
|
DMNDBK 360 1.25 SLD CRX145CM OAS
|
Facility
OP
|
$10,790.00
|
|
| Hospital Charge Code |
40005129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,776.50 |
| Max. Negotiated Rate |
$8,632.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,934.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,395.00
|
| Rate for Payer: Aetna Government |
$5,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,632.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,337.20
|
| Rate for Payer: Group Health Inc Commercial |
$5,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,776.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,395.00
|
|
|
DMNDBK 360 1.50 SLD CRX145CM OAS
|
Facility
OP
|
$10,790.00
|
|
| Hospital Charge Code |
40005130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,776.50 |
| Max. Negotiated Rate |
$8,632.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,934.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,395.00
|
| Rate for Payer: Aetna Government |
$5,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,632.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,337.20
|
| Rate for Payer: Group Health Inc Commercial |
$5,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,776.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,395.00
|
|
|
DMNDBK 360 2.00 SLD CRX145CM OAS
|
Facility
OP
|
$10,790.00
|
|
| Hospital Charge Code |
40005131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,776.50 |
| Max. Negotiated Rate |
$8,632.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,934.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,395.00
|
| Rate for Payer: Aetna Government |
$5,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,632.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,337.20
|
| Rate for Payer: Group Health Inc Commercial |
$5,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,776.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,395.00
|
|
