|
APPLICATOR CALGISWAB TYPE 1
|
Facility
OP
|
$0.75
|
|
| Hospital Charge Code |
64902452
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
|
|
APPLICATOR,CHLAPREP,ORANG,26 ML
|
Facility
OP
|
$18.14
|
|
| Hospital Charge Code |
64903894
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$14.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.07
|
| Rate for Payer: Aetna Government |
$9.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.34
|
| Rate for Payer: Group Health Inc Commercial |
$9.07
|
| Rate for Payer: Group Health Inc Medicare |
$6.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.07
|
|
|
APPLICATOR CHLORASCRUB 1.0ML SWAB
|
Facility
OP
|
$0.99
|
|
| Hospital Charge Code |
64901017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
APPLICATOR CHLORO PREP 10.5ML
|
Facility
OP
|
$9.14
|
|
| Hospital Charge Code |
64902625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.57
|
| Rate for Payer: Aetna Government |
$4.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.22
|
| Rate for Payer: Group Health Inc Commercial |
$4.57
|
| Rate for Payer: Group Health Inc Medicare |
$3.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.57
|
|
|
APPLICATOR COTTON STERILE
|
Facility
OP
|
$0.06
|
|
| Hospital Charge Code |
64901164
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
|
|
APPLICATOR, COTTON-TIP WOOD,6
|
Facility
OP
|
$2.26
|
|
| Hospital Charge Code |
64906331
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.13
|
| Rate for Payer: Aetna Government |
$1.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.54
|
| Rate for Payer: Group Health Inc Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.13
|
|
|
APPLICATOR SILVER NITRATE
|
Facility
OP
|
$16.34
|
|
| Hospital Charge Code |
40201025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$13.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.17
|
| Rate for Payer: Aetna Government |
$8.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.11
|
| Rate for Payer: Group Health Inc Commercial |
$8.17
|
| Rate for Payer: Group Health Inc Medicare |
$5.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.17
|
|
|
APPLICATOR SILVER NITRATE
|
Facility
OP
|
$20.43
|
|
| Hospital Charge Code |
64902697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.22
|
| Rate for Payer: Aetna Government |
$10.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.89
|
| Rate for Payer: Group Health Inc Commercial |
$10.22
|
| Rate for Payer: Group Health Inc Medicare |
$7.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.22
|
|
|
APPLICTION OF FINGER SPLINT
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 29130
|
| Hospital Charge Code |
30103220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
APPLIED MEDICAL STENT 6FR X 24CM
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
40209384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.14
|
| Rate for Payer: Aetna Government |
$10.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$175.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
APPLIED MEDICAL STENT 6FR X 24CM
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
40209384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
|
|
APPLIER,CLIP,LIGA,20SMALL,9 3/8
|
Facility
OP
|
$135.79
|
|
| Hospital Charge Code |
64902976
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$108.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.90
|
| Rate for Payer: Aetna Government |
$67.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.34
|
| Rate for Payer: Group Health Inc Commercial |
$67.90
|
| Rate for Payer: Group Health Inc Medicare |
$47.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.90
|
|
|
APPLIER,CLIP,LIGACLIP,MD/LG,STER
|
Facility
OP
|
$224.40
|
|
| Hospital Charge Code |
64903025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.20
|
| Rate for Payer: Aetna Government |
$112.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$179.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$152.59
|
| Rate for Payer: Group Health Inc Commercial |
$112.20
|
| Rate for Payer: Group Health Inc Medicare |
$78.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.20
|
|
|
APPLIER,CLIP,LIGACLIP,MULTI,20LRG
|
Facility
OP
|
$140.51
|
|
| Hospital Charge Code |
64905445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.18 |
| Max. Negotiated Rate |
$112.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.26
|
| Rate for Payer: Aetna Government |
$70.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.55
|
| Rate for Payer: Group Health Inc Commercial |
$70.26
|
| Rate for Payer: Group Health Inc Medicare |
$49.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.26
|
|
|
APPLIER,CLIP,LIGA,MULTI,20MD,11
|
Facility
OP
|
$136.39
|
|
| Hospital Charge Code |
64902977
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$109.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$75.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$68.20
|
| Rate for Payer: Aetna Government |
$68.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.75
|
| Rate for Payer: Group Health Inc Commercial |
$68.20
|
| Rate for Payer: Group Health Inc Medicare |
$47.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.20
|
|
|
APPLY BONE FIXATION DEVICE
|
Facility
OP
|
$17,690.84
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
30106419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$8,845.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$8,273.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$675.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,845.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8,273.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
APPLY FINGER CAST
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
30301500
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
APPLY FINGER CAST
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29086
|
| Hospital Charge Code |
30101223
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$182.22
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
APPLY FOREARM CAST
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
30301503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| 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 |
$310.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.98
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$295.04
|
|
|
APPLY FOREARM CAST
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29075
|
| Hospital Charge Code |
30101187
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$310.57
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| 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 |
$310.57
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$295.04
|
|
|
APPLY FOREARM SPLINT LEVEL 1
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
30103070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
APPLY FOREARM SPLINT LEVEL 2
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
30100165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.68 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
APPLY FOREARM SPLINT LEVEL(2)
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 29125
|
| Hospital Charge Code |
30301505
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.68 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
APPLY FOREMAN SPLINT LEVEL 1
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 29126
|
| Hospital Charge Code |
30305083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
APPLY HAND /WRIST CAST
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29085
|
| Hospital Charge Code |
30101202
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
