|
FIRST PLUS BED
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
40209304
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| 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
|
|
|
FIRST SELECT BED
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
40209308
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| 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
|
|
|
FIRST STEP HEAVY DUTY BED
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
40209300
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| 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
|
|
|
Fissurectomy, including sphincterotomy, when performed
|
Facility
OP
|
$3,246.99
|
|
|
Service Code
|
CPT 46200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$378.14 |
| Max. Negotiated Rate |
$3,246.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| 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 |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$378.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$420.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
FISTULA PLUG
|
Facility
OP
|
$2,825.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
41300008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$2,966.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,553.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.50
|
| Rate for Payer: Aetna Government |
$73.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,412.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,624.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,966.25
|
| Rate for Payer: Group Health Inc Commercial |
$1,412.50
|
| Rate for Payer: Group Health Inc Medicare |
$988.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,412.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,412.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,836.25
|
|
|
FISTULA PLUG
|
Facility
IP
|
$2,825.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
41300008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,412.50 |
| Max. Negotiated Rate |
$1,412.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,412.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,412.50
|
|
|
FISTULECTOMY
|
Facility
OP
|
$7,099.93
|
|
|
Service Code
|
HCPCS 46270
|
| Hospital Charge Code |
40011350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$453.74 |
| Max. Negotiated Rate |
$3,549.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| 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 |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$453.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,549.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$504.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 66170
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,158.21 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,694.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,694.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,158.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,290.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,398.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,694.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,398.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,694.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,694.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,694.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,286.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,694.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,155.90
|
| Rate for Payer: Wellcare Medicare |
$2,560.14
|
|
|
FIT FLOSEAL HEMOSTATIC MATRIX
|
Facility
OP
|
$367.00
|
|
| Hospital Charge Code |
40205974
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$128.45 |
| Max. Negotiated Rate |
$293.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$201.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$183.50
|
| Rate for Payer: Aetna Government |
$183.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$293.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$249.56
|
| Rate for Payer: Group Health Inc Commercial |
$183.50
|
| Rate for Payer: Group Health Inc Medicare |
$128.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$183.50
|
|
|
FITTING FRAME FIXATOR 4.2MM AO
|
Facility
OP
|
$482.50
|
|
| Hospital Charge Code |
64906485
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$386.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$265.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$241.25
|
| Rate for Payer: Aetna Government |
$241.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$386.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$328.10
|
| Rate for Payer: Group Health Inc Commercial |
$241.25
|
| Rate for Payer: Group Health Inc Medicare |
$168.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$241.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$241.25
|
|
|
FIXATION DEVICE
|
Facility
OP
|
$1,564.55
|
|
| Hospital Charge Code |
64905137
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$547.59 |
| Max. Negotiated Rate |
$1,251.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$860.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$782.28
|
| Rate for Payer: Aetna Government |
$782.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,251.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,063.89
|
| Rate for Payer: Group Health Inc Commercial |
$782.28
|
| Rate for Payer: Group Health Inc Medicare |
$547.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$782.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$782.28
|
|
|
FIXATION OF ANKLE JOINT
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 27860
|
| Hospital Charge Code |
40029644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$182.21 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
FIXATION OF KNEE JOINT
|
Facility
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
40024264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| Rate for Payer: Group Health Inc Commercial |
$1,858.61
|
| Rate for Payer: Group Health Inc Medicare |
$1,858.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
FIXATION OF SHOULDER
|
Facility
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
40029933
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$222.93 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| Rate for Payer: Group Health Inc Commercial |
$1,858.61
|
| Rate for Payer: Group Health Inc Medicare |
$1,858.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$247.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
FIXATOR LG ADJUST LONG BONE
|
Facility
OP
|
$6,072.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$6,375.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,339.60
|
| 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 |
$3,036.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,491.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,375.60
|
| Rate for Payer: Group Health Inc Commercial |
$3,036.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,125.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,036.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,036.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,946.80
|
|
|
FIXATOR LG ADJUST LONG BONE
|
Facility
IP
|
$6,072.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,036.00 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,036.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,036.00
|
|
|
FIXER SPECTRA 1 GAL
|
Facility
OP
|
$29.38
|
|
| Hospital Charge Code |
64902309
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.69
|
| Rate for Payer: Aetna Government |
$14.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.98
|
| Rate for Payer: Group Health Inc Commercial |
$14.69
|
| Rate for Payer: Group Health Inc Medicare |
$10.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.69
|
|
|
FIXOS 4.0 X 32
|
Facility
OP
|
$1,168.75
|
|
| Hospital Charge Code |
64906007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$409.06 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$642.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$584.38
|
| Rate for Payer: Aetna Government |
$584.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$935.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$794.75
|
| Rate for Payer: Group Health Inc Commercial |
$584.38
|
| Rate for Payer: Group Health Inc Medicare |
$409.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$584.38
|
|
|
FIXOS-GUIDE WIRE 1.4 X 150 MM
|
Facility
OP
|
$75.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
64906008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.75
|
| Rate for Payer: Group Health Inc Commercial |
$37.98
|
| Rate for Payer: Group Health Inc Medicare |
$26.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.37
|
|
|
FIXOS-GUIDE WIRE 1.4 X 150 MM
|
Facility
IP
|
$75.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
64906008
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$37.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.98
|
|
|
FIX PARTIAL DENTURE SECTION
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
HCPCS D9120
|
| Hospital Charge Code |
42303432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.44
|
| Rate for Payer: Aetna Government |
$31.44
|
| 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 |
$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
|
|
|
FLAT BLADE
|
Facility
OP
|
$375.00
|
|
| Hospital Charge Code |
64907164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$187.50
|
| Rate for Payer: Aetna Government |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$300.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$255.00
|
| Rate for Payer: Group Health Inc Commercial |
$187.50
|
| Rate for Payer: Group Health Inc Medicare |
$131.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.50
|
|
|
FLATUS BAG
|
Facility
OP
|
$6.03
|
|
| Hospital Charge Code |
40207618
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.10
|
| Rate for Payer: Group Health Inc Commercial |
$3.02
|
| Rate for Payer: Group Health Inc Medicare |
$2.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.02
|
|
|
FL BARIUM ENEMA W/AIR
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74280 TC
|
| Hospital Charge Code |
41102102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.64 |
| 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 |
$183.64
|
| 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 |
$204.04
|
|
|
FL BARIUM ENEMA W/O AIR
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74270 TC
|
| Hospital Charge Code |
41102104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.99 |
| 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 |
$118.99
|
| 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 |
$132.21
|
|
