|
FRACTURE PLATE -14 HOLE
|
Facility
|
IP
|
$1,102.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.00 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$551.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$551.00
|
|
|
FRACTURE PLATE 4H WITH BAR
|
Facility
|
OP
|
$619.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$650.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$340.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$371.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$309.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$356.41
|
| Rate for Payer: EmblemHealth Commercial |
$309.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$650.83
|
| Rate for Payer: Group Health Inc Commercial |
$309.92
|
| Rate for Payer: Group Health Inc Medicare |
$216.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$402.90
|
|
|
FRACTURE PLATE 4H WITH BAR
|
Facility
|
IP
|
$619.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.92 |
| Max. Negotiated Rate |
$309.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.92
|
|
|
FRACTURE PLATE - HOLES
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.00
|
|
|
FRACTURE PLATE - HOLES
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$243.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$265.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$221.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$254.15
|
| Rate for Payer: EmblemHealth Commercial |
$221.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$464.10
|
| Rate for Payer: Group Health Inc Commercial |
$221.00
|
| Rate for Payer: Group Health Inc Medicare |
$154.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.30
|
|
|
FRACTURE PLT, 4 HOLES
|
Facility
|
OP
|
$582.12
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$611.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$320.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Brighton Health Commercial |
$349.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$291.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$334.72
|
| Rate for Payer: EmblemHealth Commercial |
$291.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$611.23
|
| Rate for Payer: Group Health Inc Commercial |
$291.06
|
| Rate for Payer: Group Health Inc Medicare |
$203.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.38
|
|
|
FRACTURE PLT, 4 HOLES
|
Facility
|
IP
|
$582.12
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$291.06 |
| Max. Negotiated Rate |
$291.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.06
|
|
|
FRACTURE PLT, 6 HOLES
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.00 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$356.00
|
|
|
FRACTURE PLT, 6 HOLES
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209733
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$747.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$391.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Brighton Health Commercial |
$427.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$356.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$409.40
|
| Rate for Payer: EmblemHealth Commercial |
$356.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.60
|
| Rate for Payer: Group Health Inc Commercial |
$356.00
|
| Rate for Payer: Group Health Inc Medicare |
$249.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$356.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$462.80
|
|
|
FRACTURES OF FEMUR WITH MCC
|
Facility
|
IP
|
$41,182.76
|
|
|
Service Code
|
MSDRG 533
|
| Min. Negotiated Rate |
$13,927.26 |
| Max. Negotiated Rate |
$41,182.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,054.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,951.10
|
| Rate for Payer: Aetna Government |
$29,951.10
|
| Rate for Payer: Brighton Health Commercial |
$23,655.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,550.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,172.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,249.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,453.54
|
| Rate for Payer: EmblemHealth Commercial |
$13,989.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,951.10
|
| Rate for Payer: Group Health Inc Commercial |
$29,951.10
|
| Rate for Payer: Group Health Inc Medicare |
$29,951.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,951.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,927.26
|
| Rate for Payer: Humana Medicare |
$41,182.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,951.10
|
| Rate for Payer: United Healthcare Commercial |
$32,443.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,951.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,951.10
|
| Rate for Payer: Wellcare Medicare |
$28,453.54
|
|
|
FRACTURES OF FEMUR WITHOUT MCC
|
Facility
|
IP
|
$25,520.56
|
|
|
Service Code
|
MSDRG 534
|
| Min. Negotiated Rate |
$6,945.75 |
| Max. Negotiated Rate |
$25,520.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,943.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,560.41
|
| Rate for Payer: Aetna Government |
$18,560.41
|
| Rate for Payer: Brighton Health Commercial |
$11,745.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,931.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,987.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,543.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,632.39
|
| Rate for Payer: EmblemHealth Commercial |
$6,945.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,560.41
|
| Rate for Payer: Group Health Inc Commercial |
$18,560.41
|
| Rate for Payer: Group Health Inc Medicare |
$18,560.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,560.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,630.59
|
| Rate for Payer: Humana Medicare |
$25,520.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,560.41
|
| Rate for Payer: United Healthcare Commercial |
$16,108.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,560.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,560.41
|
| Rate for Payer: Wellcare Medicare |
$17,632.39
|
|
|
FRACTURES OF HIP AND PELVIS WITH MCC
|
Facility
|
IP
|
$34,800.80
|
|
|
Service Code
|
MSDRG 535
|
| Min. Negotiated Rate |
$11,119.20 |
| Max. Negotiated Rate |
$34,800.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,119.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,309.67
|
| Rate for Payer: Aetna Government |
$25,309.67
|
| Rate for Payer: Brighton Health Commercial |
$18,802.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,815.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,392.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,479.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,044.19
|
| Rate for Payer: EmblemHealth Commercial |
$11,119.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,309.67
|
| Rate for Payer: Group Health Inc Commercial |
$25,309.67
|
| Rate for Payer: Group Health Inc Medicare |
$25,309.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,309.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,769.00
|
| Rate for Payer: Humana Medicare |
$34,800.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,309.67
|
| Rate for Payer: United Healthcare Commercial |
$25,787.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,309.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,309.67
|
| Rate for Payer: Wellcare Medicare |
$24,044.19
|
|
|
FRACTURES OF HIP AND PELVIS WITHOUT MCC
|
Facility
|
IP
|
$25,083.93
|
|
|
Service Code
|
MSDRG 536
|
| Min. Negotiated Rate |
$6,749.38 |
| Max. Negotiated Rate |
$25,083.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,605.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,242.86
|
| Rate for Payer: Aetna Government |
$18,242.86
|
| Rate for Payer: Brighton Health Commercial |
$11,412.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,607.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,592.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,217.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,330.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,749.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,242.86
|
| Rate for Payer: Group Health Inc Commercial |
$18,242.86
|
| Rate for Payer: Group Health Inc Medicare |
$18,242.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,242.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,482.93
|
| Rate for Payer: Humana Medicare |
$25,083.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,242.86
|
| Rate for Payer: United Healthcare Commercial |
$15,653.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,242.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,242.86
|
| Rate for Payer: Wellcare Medicare |
$17,330.72
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC
|
Facility
|
IP
|
$39,071.96
|
|
|
Service Code
|
MSDRG 562
|
| Min. Negotiated Rate |
$13,040.00 |
| Max. Negotiated Rate |
$39,071.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,422.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,415.97
|
| Rate for Payer: Aetna Government |
$28,415.97
|
| Rate for Payer: Brighton Health Commercial |
$22,050.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,984.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,260.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,671.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,995.17
|
| Rate for Payer: EmblemHealth Commercial |
$13,040.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,415.97
|
| Rate for Payer: Group Health Inc Commercial |
$28,415.97
|
| Rate for Payer: Group Health Inc Medicare |
$28,415.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,415.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,213.43
|
| Rate for Payer: Humana Medicare |
$39,071.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,415.97
|
| Rate for Payer: United Healthcare Commercial |
$30,242.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,415.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,415.97
|
| Rate for Payer: Wellcare Medicare |
$26,995.17
|
|
|
FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC
|
Facility
|
IP
|
$27,152.77
|
|
|
Service Code
|
MSDRG 563
|
| Min. Negotiated Rate |
$7,679.77 |
| Max. Negotiated Rate |
$27,152.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,205.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,747.47
|
| Rate for Payer: Aetna Government |
$19,747.47
|
| Rate for Payer: Brighton Health Commercial |
$12,986.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,142.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,466.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,763.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,760.10
|
| Rate for Payer: EmblemHealth Commercial |
$7,679.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,747.47
|
| Rate for Payer: Group Health Inc Commercial |
$19,747.47
|
| Rate for Payer: Group Health Inc Medicare |
$19,747.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,747.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,182.57
|
| Rate for Payer: Humana Medicare |
$27,152.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,747.47
|
| Rate for Payer: United Healthcare Commercial |
$17,810.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,747.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,747.47
|
| Rate for Payer: Wellcare Medicare |
$18,760.10
|
|
|
FRAGILE X, PCR REFLEX SOUTHERN
|
Facility
|
OP
|
$142.60
|
|
|
Service Code
|
HCPCS 81243
|
| Hospital Charge Code |
40629205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.93 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.04
|
| Rate for Payer: Aetna Government |
$57.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.93
|
| Rate for Payer: Brighton Health Commercial |
$57.04
|
| Rate for Payer: Cash Price |
$57.04
|
| Rate for Payer: Cash Price |
$57.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$96.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$57.04
|
| Rate for Payer: EmblemHealth Commercial |
$57.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.77
|
| Rate for Payer: Group Health Inc Commercial |
$57.04
|
| Rate for Payer: Group Health Inc Medicare |
$57.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.04
|
| Rate for Payer: Healthfirst QHP |
$57.04
|
| Rate for Payer: Humana Medicare |
$58.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45.63
|
| Rate for Payer: Wellcare Medicare |
$51.34
|
|
|
FRAGILE X, PCR REFLEX SOUTHERN
|
Facility
|
IP
|
$142.60
|
|
|
Service Code
|
HCPCS 81243
|
| Hospital Charge Code |
40629205
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$57.04
|
|
|
FREE HAND TARG DRILL 4.3MM
|
Facility
|
IP
|
$208.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.40
|
|
|
FREE HAND TARG DRILL 4.3MM
|
Facility
|
OP
|
$208.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006472
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$219.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$125.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.06
|
| Rate for Payer: EmblemHealth Commercial |
$104.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$219.24
|
| Rate for Payer: Group Health Inc Commercial |
$104.40
|
| Rate for Payer: Group Health Inc Medicare |
$73.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.72
|
|
|
FREE KAPPA/LAMBDA
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
40608229
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$13.60
|
|
|
FREE KAPPA/LAMBDA
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
40608229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.60
|
| Rate for Payer: Aetna Government |
$13.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.52
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.60
|
| Rate for Payer: EmblemHealth Commercial |
$13.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.10
|
| Rate for Payer: Group Health Inc Commercial |
$13.60
|
| Rate for Payer: Group Health Inc Medicare |
$13.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.60
|
| Rate for Payer: Healthfirst QHP |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.88
|
| Rate for Payer: Wellcare Medicare |
$12.24
|
|
|
FREE K+L LT CHAINS,QN,S
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
40609101
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.60
|
| Rate for Payer: Aetna Government |
$13.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.52
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.60
|
| Rate for Payer: EmblemHealth Commercial |
$13.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.10
|
| Rate for Payer: Group Health Inc Commercial |
$13.60
|
| Rate for Payer: Group Health Inc Medicare |
$13.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.60
|
| Rate for Payer: Healthfirst QHP |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.88
|
| Rate for Payer: Wellcare Medicare |
$12.24
|
|
|
FREE K+L LT CHAINS,QN,S
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 83883
|
| Hospital Charge Code |
40609101
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.60
|
|
|
FRENECTOMY
|
Facility
|
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
40019585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.52 |
| Max. Negotiated Rate |
$3,065.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,234.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,234.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,234.52
|
| Rate for Payer: Brighton Health Commercial |
$3,065.12
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| 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 |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Humana Medicare |
$1,798.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
FRENECTOMY
|
Facility
|
IP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 40819
|
| Hospital Charge Code |
40019585
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,763.60
|
|
