|
ANESTHESIA EXT. SET
|
Facility
OP
|
$2.48
|
|
| Hospital Charge Code |
40509815
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna Government |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.24
|
|
|
ANESTHESIA TIME 1ST HOUR
|
Facility
OP
|
$1,215.00
|
|
| Hospital Charge Code |
40004410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$668.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$607.50
|
| Rate for Payer: Aetna Government |
$607.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$972.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$826.20
|
| Rate for Payer: Group Health Inc Commercial |
$607.50
|
| Rate for Payer: Group Health Inc Medicare |
$425.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$607.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$607.50
|
|
|
ANESTHESIA TIME ADD'L 15 MINS
|
Facility
OP
|
$121.50
|
|
| Hospital Charge Code |
64900711
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60.75
|
| Rate for Payer: Aetna Government |
$60.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.62
|
| Rate for Payer: Group Health Inc Commercial |
$60.75
|
| Rate for Payer: Group Health Inc Medicare |
$42.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.75
|
|
|
ANESTHESIA TIME EA ADDL 15 MIN
|
Facility
OP
|
$121.50
|
|
| Hospital Charge Code |
40004411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60.75
|
| Rate for Payer: Aetna Government |
$60.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.62
|
| Rate for Payer: Group Health Inc Commercial |
$60.75
|
| Rate for Payer: Group Health Inc Medicare |
$42.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.75
|
|
|
ANESTHESIA TIME FIRST HOUR
|
Facility
OP
|
$1,215.00
|
|
| Hospital Charge Code |
64900710
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$668.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$607.50
|
| Rate for Payer: Aetna Government |
$607.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$972.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$826.20
|
| Rate for Payer: Group Health Inc Commercial |
$607.50
|
| Rate for Payer: Group Health Inc Medicare |
$425.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$607.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$607.50
|
|
|
ANGEL BLOOD ACCESS KT
|
Facility
OP
|
$270.00
|
|
| Hospital Charge Code |
64905940
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.00
|
| Rate for Payer: Aetna Government |
$135.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$216.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$183.60
|
| Rate for Payer: Group Health Inc Commercial |
$135.00
|
| Rate for Payer: Group Health Inc Medicare |
$94.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
|
|
ANGELMAN/PWS METHYLATION ASSAY
|
Facility
OP
|
$127.68
|
|
|
Service Code
|
HCPCS 81331
|
| Hospital Charge Code |
40609029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.86 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.07
|
| Rate for Payer: Aetna Government |
$51.07
|
| Rate for Payer: Brighton Health Commercial |
$51.07
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Cash Price |
$51.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$51.07
|
| Rate for Payer: EmblemHealth Commercial |
$51.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.45
|
| Rate for Payer: Group Health Inc Commercial |
$51.07
|
| Rate for Payer: Group Health Inc Medicare |
$51.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.07
|
| Rate for Payer: Healthfirst QHP |
$51.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.86
|
| Rate for Payer: Wellcare Medicare |
$45.96
|
|
|
ANGINA PECTORIS
|
Facility
IP
|
$17,348.81
|
|
|
Service Code
|
MS-DRG 311
|
| Min. Negotiated Rate |
$5,986.21 |
| Max. Negotiated Rate |
$17,348.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,293.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,008.64
|
| Rate for Payer: Aetna Government |
$17,008.64
|
| Rate for Payer: Brighton Health Commercial |
$10,122.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,348.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,055.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,948.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,158.21
|
| Rate for Payer: EmblemHealth Commercial |
$5,986.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,008.64
|
| Rate for Payer: Group Health Inc Commercial |
$17,008.64
|
| Rate for Payer: Group Health Inc Medicare |
$17,008.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,008.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,909.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,008.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,008.64
|
| Rate for Payer: Wellcare Medicare |
$16,158.21
|
|
|
ANGIO CATHETER
|
Facility
OP
|
$12.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
64907115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.12
|
| Rate for Payer: Group Health Inc Commercial |
$6.25
|
| Rate for Payer: Group Health Inc Medicare |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.12
|
|
|
ANGIO CATHETER
|
Facility
IP
|
$12.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
64907115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.25
|
|
|
ANGIODYNAMICS MINI STICK MAX 5F
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
66570999
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.00
|
| Rate for Payer: Aetna Government |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
| Rate for Payer: Group Health Inc Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
|
|
ANGIOGRAM TRAY
|
Facility
OP
|
$63.43
|
|
| Hospital Charge Code |
40200340
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.72
|
| Rate for Payer: Aetna Government |
$31.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.13
|
| Rate for Payer: Group Health Inc Commercial |
$31.72
|
| Rate for Payer: Group Health Inc Medicare |
$22.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.72
|
|
|
ANGIOGRAPHIC CATH SET
|
Facility
OP
|
$49.60
|
|
| Hospital Charge Code |
66524677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$39.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.80
|
| Rate for Payer: Aetna Government |
$24.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.73
|
| Rate for Payer: Group Health Inc Commercial |
$24.80
|
| Rate for Payer: Group Health Inc Medicare |
$17.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.80
|
|
|
Angiography, extremity, unilateral, radiological supervision and interpretation
|
Facility
OP
|
$3,686.08
|
|
|
Service Code
|
CPT 75710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$166.03 |
| Max. Negotiated Rate |
$3,686.08 |
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,317.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
ANGIOTENSIN CONVERT ENZ., CSF
|
Facility
OP
|
$36.50
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
40609855
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.60
|
| Rate for Payer: Aetna Government |
$14.60
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.60
|
| Rate for Payer: EmblemHealth Commercial |
$14.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.99
|
| Rate for Payer: Group Health Inc Commercial |
$14.60
|
| Rate for Payer: Group Health Inc Medicare |
$14.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.60
|
| Rate for Payer: Healthfirst QHP |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.68
|
| Rate for Payer: Wellcare Medicare |
$13.14
|
|
|
ANGIOTENSIN-CONVERTING ENZYME
|
Facility
OP
|
$36.50
|
|
|
Service Code
|
HCPCS 82164
|
| Hospital Charge Code |
40609044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$23.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.60
|
| Rate for Payer: Aetna Government |
$14.60
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Cash Price |
$14.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.60
|
| Rate for Payer: EmblemHealth Commercial |
$14.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.99
|
| Rate for Payer: Group Health Inc Commercial |
$14.60
|
| Rate for Payer: Group Health Inc Medicare |
$14.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.60
|
| Rate for Payer: Healthfirst QHP |
$14.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.68
|
| Rate for Payer: Wellcare Medicare |
$13.14
|
|
|
ANGLED CUTTER 4.5MM TOMCAT
|
Facility
OP
|
$100.00
|
|
| Hospital Charge Code |
64905672
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.00
|
| Rate for Payer: Aetna Government |
$50.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
ANGLED POST
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
ANGLED POST
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200739
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| 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 |
$50.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.00
|
|
|
ANGLE FRACTURE PLT,6HOLES 115
|
Facility
IP
|
$1,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.00
|
|
|
ANGLE FRACTURE PLT,6HOLES 115
|
Facility
OP
|
$1,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,115.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$584.10
|
| 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 |
$531.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$610.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,115.10
|
| Rate for Payer: Group Health Inc Commercial |
$531.00
|
| Rate for Payer: Group Health Inc Medicare |
$371.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$690.30
|
|
|
ANGLE FRACTURE PLT,6 HOLES 140
|
Facility
OP
|
$1,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,115.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$584.10
|
| 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 |
$531.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$610.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,115.10
|
| Rate for Payer: Group Health Inc Commercial |
$531.00
|
| Rate for Payer: Group Health Inc Medicare |
$371.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$690.30
|
|
|
ANGLE FRACTURE PLT,6 HOLES 140
|
Facility
IP
|
$1,062.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.00 |
| Max. Negotiated Rate |
$531.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.00
|
|
|
ANGLE RIGHT 7 X 23 HOBS
|
Facility
OP
|
$3,598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,777.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,978.90
|
| 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 |
$1,799.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,068.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,777.90
|
| Rate for Payer: Group Health Inc Commercial |
$1,799.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,259.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,799.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,799.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,338.70
|
|
|
ANGLE RIGHT 7 X 23 HOBS
|
Facility
IP
|
$3,598.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.00 |
| Max. Negotiated Rate |
$1,799.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,799.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,799.00
|
|
