GADOXETATE DISODIUM 0.25 MMOL/ML IV SOLN [93574]
|
Facility
|
OP
|
$17.04
|
|
Service Code
|
HCPCS A9581
|
Hospital Charge Code |
50419032005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$5.96 |
Max. Negotiated Rate |
$17.89 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.37
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.73
|
Rate for Payer: Aetna Government |
$14.73
|
Rate for Payer: Brighton Health Commercial |
$10.22
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.52
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.80
|
Rate for Payer: EmblemHealth Commercial |
$8.52
|
Rate for Payer: Fidelis Medicare Advantage |
$17.89
|
Rate for Payer: Group Health Inc Commercial |
$8.52
|
Rate for Payer: Group Health Inc Medicare |
$5.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$8.52
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.07
|
|
GADOXETATE DISODIUM 181.43MG INJ
|
Facility
|
OP
|
$34.00
|
|
Service Code
|
HCPCS A9581
|
Hospital Charge Code |
41649592
|
Hospital Revenue Code
|
254
|
Min. Negotiated Rate |
$11.90 |
Max. Negotiated Rate |
$27.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.73
|
Rate for Payer: Aetna Government |
$14.73
|
Rate for Payer: Brighton Health Commercial |
$25.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
Rate for Payer: Group Health Inc Commercial |
$17.00
|
Rate for Payer: Group Health Inc Medicare |
$11.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.76
|
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.65
|
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.65
|
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.65
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
GADOXETATE DISODIUM 181.43MG INJ
|
Facility
|
OP
|
$34.00
|
|
Service Code
|
HCPCS A9581
|
Hospital Charge Code |
41659592
|
Hospital Revenue Code
|
254
|
Min. Negotiated Rate |
$11.90 |
Max. Negotiated Rate |
$27.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.73
|
Rate for Payer: Aetna Government |
$14.73
|
Rate for Payer: Brighton Health Commercial |
$25.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
Rate for Payer: Group Health Inc Commercial |
$17.00
|
Rate for Payer: Group Health Inc Medicare |
$11.90
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.76
|
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.65
|
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.65
|
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.65
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
GAG MOLT MOUTH ADULT
|
Facility
|
OP
|
$253.75
|
|
Hospital Charge Code |
64904740
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$88.81 |
Max. Negotiated Rate |
$203.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$139.56
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$126.88
|
Rate for Payer: Aetna Government |
$126.88
|
Rate for Payer: Brighton Health Commercial |
$190.31
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$203.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$172.55
|
Rate for Payer: Group Health Inc Commercial |
$126.88
|
Rate for Payer: Group Health Inc Medicare |
$88.81
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.88
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$126.88
|
|
GALLANT DR ICD
|
Facility
|
IP
|
$38,750.00
|
|
Service Code
|
HCPCS C1721
|
Hospital Charge Code |
66571449
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$19,375.00 |
Max. Negotiated Rate |
$19,375.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,375.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$19,375.00
|
|
GALLANT DR ICD
|
Facility
|
OP
|
$38,750.00
|
|
Service Code
|
HCPCS C1721
|
Hospital Charge Code |
66571449
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$5,000.00 |
Max. Negotiated Rate |
$40,687.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,312.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,000.00
|
Rate for Payer: Aetna Government |
$5,000.00
|
Rate for Payer: Brighton Health Commercial |
$23,250.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,375.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,281.25
|
Rate for Payer: EmblemHealth Commercial |
$19,375.00
|
Rate for Payer: Fidelis Medicare Advantage |
$40,687.50
|
Rate for Payer: Group Health Inc Commercial |
$19,375.00
|
Rate for Payer: Group Health Inc Medicare |
$13,562.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,375.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$19,375.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,187.50
|
|
GALLIUM GA-67
|
Facility
|
OP
|
$17.95
|
|
Service Code
|
HCPCS A9556
|
Hospital Charge Code |
41656584
|
Hospital Revenue Code
|
343
|
Min. Negotiated Rate |
$6.28 |
Max. Negotiated Rate |
$99.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.87
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.50
|
Rate for Payer: Aetna Government |
$99.50
|
Rate for Payer: Brighton Health Commercial |
$13.46
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.36
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.21
|
Rate for Payer: Group Health Inc Commercial |
$8.98
|
Rate for Payer: Group Health Inc Medicare |
$6.28
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.98
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$8.98
|
|
GAM 3 SYS 10X380MM X125X125 D LFT
|
Facility
|
OP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205354
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,443.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,327.71
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$2,539.32
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,116.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,433.52
|
Rate for Payer: EmblemHealth Commercial |
$2,116.10
|
Rate for Payer: Fidelis Medicare Advantage |
$4,443.81
|
Rate for Payer: Group Health Inc Commercial |
$2,116.10
|
Rate for Payer: Group Health Inc Medicare |
$1,481.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,750.93
|
|
GAM 3 SYS 10X380MM X125X125 D LFT
|
Facility
|
IP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205354
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,116.10 |
Max. Negotiated Rate |
$2,116.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
|
GAMMA3 LNG RT 11X420MX125D
|
Facility
|
IP
|
$3,245.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205200
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,622.60 |
Max. Negotiated Rate |
$1,622.60 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,622.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,622.60
|
|
GAMMA3 LNG RT 11X420MX125D
|
Facility
|
OP
|
$3,245.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40205200
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,407.46 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,784.86
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Brighton Health Commercial |
$1,947.12
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,622.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,865.99
|
Rate for Payer: EmblemHealth Commercial |
$1,622.60
|
Rate for Payer: Fidelis Medicare Advantage |
$3,407.46
|
Rate for Payer: Group Health Inc Commercial |
$1,622.60
|
Rate for Payer: Group Health Inc Medicare |
$1,135.82
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,622.60
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,622.60
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,109.38
|
|
GAMMA 3 LONG RT 11X360X130
|
Facility
|
OP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200511
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,150.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,800.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,500.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.00
|
Rate for Payer: EmblemHealth Commercial |
$1,500.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,150.00
|
Rate for Payer: Group Health Inc Commercial |
$1,500.00
|
Rate for Payer: Group Health Inc Medicare |
$1,050.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.00
|
|
GAMMA 3 LONG RT 11X360X130
|
Facility
|
IP
|
$3,000.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200511
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,500.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
|
GAMMA3 SYS 10X360X125D/LFT/L/N
|
Facility
|
IP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205615
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,116.10 |
Max. Negotiated Rate |
$2,116.10 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
|
GAMMA3 SYS 10X360X125D/LFT/L/N
|
Facility
|
OP
|
$4,232.20
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205615
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$4,443.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,327.71
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$2,539.32
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,116.10
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,433.52
|
Rate for Payer: EmblemHealth Commercial |
$2,116.10
|
Rate for Payer: Fidelis Medicare Advantage |
$4,443.81
|
Rate for Payer: Group Health Inc Commercial |
$2,116.10
|
Rate for Payer: Group Health Inc Medicare |
$1,481.27
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,116.10
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$2,116.10
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,750.93
|
|
GAMMA3 SYS11X360MMX125DEGLFTLNGNL
|
Facility
|
OP
|
$2,940.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200512
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,087.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,617.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,764.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,470.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,690.50
|
Rate for Payer: EmblemHealth Commercial |
$1,470.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,087.00
|
Rate for Payer: Group Health Inc Commercial |
$1,470.00
|
Rate for Payer: Group Health Inc Medicare |
$1,029.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,470.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,470.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,911.00
|
|
GAMMA3 SYS11X360MMX125DEGLFTLNGNL
|
Facility
|
IP
|
$2,940.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200512
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,470.00 |
Max. Negotiated Rate |
$1,470.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,470.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,470.00
|
|
GAMMA3 SYS11X400MMX125DEGLFTLNGNL
|
Facility
|
OP
|
$3,150.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200741
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,307.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,732.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$1,890.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,575.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,811.25
|
Rate for Payer: EmblemHealth Commercial |
$1,575.00
|
Rate for Payer: Fidelis Medicare Advantage |
$3,307.50
|
Rate for Payer: Group Health Inc Commercial |
$1,575.00
|
Rate for Payer: Group Health Inc Medicare |
$1,102.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,575.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,575.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,047.50
|
|
GAMMA3 SYS11X400MMX125DEGLFTLNGNL
|
Facility
|
IP
|
$3,150.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200741
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,575.00 |
Max. Negotiated Rate |
$1,575.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,575.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,575.00
|
|
GAMMA3 SYS 8X17.5MM SET SCREW, TI
|
Facility
|
IP
|
$334.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200513
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$167.30 |
Max. Negotiated Rate |
$167.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$167.30
|
|
GAMMA3 SYS 8X17.5MM SET SCREW, TI
|
Facility
|
OP
|
$334.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200513
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$117.11 |
Max. Negotiated Rate |
$351.33 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$184.03
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$200.76
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$192.40
|
Rate for Payer: EmblemHealth Commercial |
$167.30
|
Rate for Payer: Fidelis Medicare Advantage |
$351.33
|
Rate for Payer: Group Health Inc Commercial |
$167.30
|
Rate for Payer: Group Health Inc Medicare |
$117.11
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$167.30
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.49
|
|
GAMMA GLUTAMYL TRANSPEPTI
|
Facility
|
IP
|
$18.00
|
|
Service Code
|
HCPCS 82977
|
Hospital Charge Code |
40602430
|
Hospital Revenue Code
|
301
|
Rate for Payer: Cash Price |
$7.20
|
|
GAMMA GLUTAMYL TRANSPEPTI
|
Facility
|
OP
|
$18.00
|
|
Service Code
|
HCPCS 82977
|
Hospital Charge Code |
40602430
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$5.04 |
Max. Negotiated Rate |
$13.50 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.20
|
Rate for Payer: Aetna Government |
$7.20
|
Rate for Payer: Affinity Essential Plan 1&2 |
$5.04
|
Rate for Payer: Affinity Essential Plan 3&4 |
$5.04
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.04
|
Rate for Payer: Brighton Health Commercial |
$13.50
|
Rate for Payer: Cash Price |
$7.20
|
Rate for Payer: Cash Price |
$7.20
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.68
|
Rate for Payer: Elderplan Medicare Advantage |
$7.20
|
Rate for Payer: EmblemHealth Commercial |
$7.20
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$6.12
|
Rate for Payer: Fidelis Essential Plan QHP |
$6.41
|
Rate for Payer: Fidelis Medicare Advantage |
$7.20
|
Rate for Payer: Fidelis Qualified Health Plan |
$6.41
|
Rate for Payer: Group Health Inc Commercial |
$7.20
|
Rate for Payer: Group Health Inc Medicare |
$7.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$7.20
|
Rate for Payer: Healthfirst Medicare Advantage |
$7.20
|
Rate for Payer: Healthfirst QHP |
$7.20
|
Rate for Payer: Humana Medicare |
$7.34
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$7.20
|
Rate for Payer: United Healthcare Commercial |
$9.12
|
Rate for Payer: United Healthcare Medicare Advantage |
$7.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.20
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.76
|
Rate for Payer: Wellcare Medicare |
$6.48
|
|
GAMMA NAIL
|
Facility
|
OP
|
$845.54
|
|
Hospital Charge Code |
40207026
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$295.94 |
Max. Negotiated Rate |
$676.43 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$465.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$422.77
|
Rate for Payer: Aetna Government |
$422.77
|
Rate for Payer: Brighton Health Commercial |
$634.16
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$676.43
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$574.97
|
Rate for Payer: Group Health Inc Commercial |
$422.77
|
Rate for Payer: Group Health Inc Medicare |
$295.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.77
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$422.77
|
|
GAMMA NAIL/1
|
Facility
|
OP
|
$845.54
|
|
Hospital Charge Code |
40207027
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$295.94 |
Max. Negotiated Rate |
$676.43 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$465.05
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$422.77
|
Rate for Payer: Aetna Government |
$422.77
|
Rate for Payer: Brighton Health Commercial |
$634.16
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$676.43
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$574.97
|
Rate for Payer: Group Health Inc Commercial |
$422.77
|
Rate for Payer: Group Health Inc Medicare |
$295.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.77
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$422.77
|
|