|
F414-IGE TILAPIA
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729770
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$5.22
|
|
|
F414-IGE TILAPIA
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729770
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
FABRICATION OF ATHLETIC MOUTHGUAR
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS D9941
|
| Hospital Charge Code |
42302385
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.14
|
| Rate for Payer: Aetna Government |
$36.14
|
| Rate for Payer: Brighton Health Commercial |
$189.00
|
| 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 |
$126.00
|
| Rate for Payer: Group Health Inc Medicare |
$88.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.00
|
|
|
FAC BONES-COMPL REDUCT W/FIX/MU/1
|
Facility
|
OP
|
$10,631.00
|
|
|
Service Code
|
HCPCS D7780
|
| Hospital Charge Code |
42301935
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$7,973.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,847.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,007.33
|
| Rate for Payer: Aetna Government |
$3,007.33
|
| Rate for Payer: Brighton Health Commercial |
$7,973.25
|
| 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 |
$5,315.50
|
| Rate for Payer: Group Health Inc Medicare |
$3,720.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,315.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,315.50
|
|
|
FAC BONES-COMPL REDUCT W/FIX/MULT
|
Facility
|
OP
|
$7,796.00
|
|
|
Service Code
|
HCPCS D7680
|
| Hospital Charge Code |
42301895
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,255.53 |
| Max. Negotiated Rate |
$5,847.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,287.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,255.53
|
| Rate for Payer: Aetna Government |
$2,255.53
|
| Rate for Payer: Brighton Health Commercial |
$5,847.00
|
| 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 |
$3,898.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,728.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,898.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,898.00
|
|
|
FACIAL AUGMENTATION IMPLANT PROST
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS D5925
|
| Hospital Charge Code |
42301265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$539.47
|
| Rate for Payer: Aetna Government |
$539.47
|
| Rate for Payer: Brighton Health Commercial |
$269.25
|
| 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 |
$179.50
|
| Rate for Payer: Group Health Inc Medicare |
$125.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.50
|
|
|
FACIAL MOULAGE (COMPLETE)
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS D5912
|
| Hospital Charge Code |
42301220
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
FACIAL MOULAGE (COMPLETE)
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS D5912
|
| Hospital Charge Code |
42301220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$326.25
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
FACIAL MOULAGE (SECTIONAL)
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS D5911
|
| Hospital Charge Code |
42301215
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
FACIAL MOULAGE (SECTIONAL)
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS D5911
|
| Hospital Charge Code |
42301215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$159.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$217.50
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
FACIAL PROSTHESIS
|
Facility
|
OP
|
$3,014.00
|
|
|
Service Code
|
HCPCS D5919
|
| Hospital Charge Code |
42301245
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,054.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,657.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,507.00
|
| Rate for Payer: Aetna Government |
$1,507.00
|
| Rate for Payer: Brighton Health Commercial |
$2,260.50
|
| 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 |
$1,507.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,054.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,507.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,507.00
|
|
|
FACIAL PROSTHESIS, REPLACEMENT
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS D5929
|
| Hospital Charge Code |
42301285
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$179.50
|
| Rate for Payer: Aetna Government |
$179.50
|
| Rate for Payer: Brighton Health Commercial |
$269.25
|
| 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 |
$179.50
|
| Rate for Payer: Group Health Inc Medicare |
$125.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.50
|
|
|
FACIOTOMY ARM DECOMPRESSION
|
Facility
|
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 25020
|
| Hospital Charge Code |
40013195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,301.03 |
| Max. Negotiated Rate |
$3,078.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,301.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,301.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,301.03
|
| Rate for Payer: Brighton Health Commercial |
$3,078.85
|
| 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 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 Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Humana Medicare |
$1,895.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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
|
|
|
FACIOTOMY ARM DECOMPRESSION
|
Facility
|
IP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 25020
|
| Hospital Charge Code |
40013195
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,858.61
|
|
|
FACIOTOMY ENDOSCOPIC PLANTAR
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29893
|
| Hospital Charge Code |
40083198
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| 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 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 Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
|
|
FACIOTOMY ENDOSCOPIC PLANTAR
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29893
|
| Hospital Charge Code |
40083198
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
FACIOTOMY LEG LOWER DECOMPRESSION
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
40013197
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
FACIOTOMY LEG LOWER DECOMPRESSION
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
40013197
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| 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 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 Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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
|
|
|
FACIOTOMY LEG UPPER DECOMPRESSION
|
Facility
|
IP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 27498
|
| Hospital Charge Code |
40013196
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,858.61
|
|
|
FACIOTOMY LEG UPPER DECOMPRESSION
|
Facility
|
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 27498
|
| Hospital Charge Code |
40013196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,301.03 |
| Max. Negotiated Rate |
$3,078.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,301.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,301.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,301.03
|
| Rate for Payer: Brighton Health Commercial |
$3,078.85
|
| 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 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 Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Humana Medicare |
$1,895.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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
|
|
|
FACTOR_II_ACTIVITY
|
Facility
|
IP
|
$32.45
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
40629732
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$12.98
|
|
|
FACTOR_II_ACTIVITY
|
Facility
|
OP
|
$32.45
|
|
|
Service Code
|
HCPCS 85210
|
| Hospital Charge Code |
40629732
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.98
|
| Rate for Payer: Aetna Government |
$12.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.09
|
| Rate for Payer: Brighton Health Commercial |
$24.34
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.98
|
| Rate for Payer: EmblemHealth Commercial |
$12.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.55
|
| Rate for Payer: Group Health Inc Commercial |
$12.98
|
| Rate for Payer: Group Health Inc Medicare |
$12.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.98
|
| Rate for Payer: Healthfirst QHP |
$12.98
|
| Rate for Payer: Humana Medicare |
$13.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.98
|
| Rate for Payer: United Healthcare Commercial |
$16.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.38
|
| Rate for Payer: Wellcare Medicare |
$11.68
|
|
|
FACTOR II, DNA ANALYSIS
|
Facility
|
IP
|
$164.23
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
40629203
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$65.69
|
|
|
FACTOR II, DNA ANALYSIS
|
Facility
|
OP
|
$164.23
|
|
|
Service Code
|
HCPCS 81240
|
| Hospital Charge Code |
40629203
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.98 |
| Max. Negotiated Rate |
$131.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.69
|
| Rate for Payer: Aetna Government |
$65.69
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45.98
|
| Rate for Payer: Brighton Health Commercial |
$65.69
|
| Rate for Payer: Cash Price |
$65.69
|
| Rate for Payer: Cash Price |
$65.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$131.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$111.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$65.69
|
| Rate for Payer: EmblemHealth Commercial |
$65.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.46
|
| Rate for Payer: Group Health Inc Commercial |
$65.69
|
| Rate for Payer: Group Health Inc Medicare |
$65.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.69
|
| Rate for Payer: Healthfirst QHP |
$65.69
|
| Rate for Payer: Humana Medicare |
$67.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.69
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$52.55
|
| Rate for Payer: Wellcare Medicare |
$59.12
|
|
|
FACTOR IX/500IU
|
Facility
|
IP
|
$47.60
|
|
|
Service Code
|
HCPCS 85250
|
| Hospital Charge Code |
40701006
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$19.04
|
|
