Arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal joint
|
Facility
OP
|
$2,915.00
|
|
Service Code
|
CPT 26070
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$366.90 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
Rate for Payer: Aetna Government |
$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 CHP/HARP/Medicaid |
$366.90
|
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 Medicare |
$1,858.61
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$407.67
|
Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
Rate for Payer: Healthfirst QHP |
$1,858.61
|
Rate for Payer: Senior Whole Health 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
|
|
ARTHROWAND CUTTING SABER 30
|
Facility
OP
|
$517.50
|
|
Hospital Charge Code |
64903023
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$181.12 |
Max. Negotiated Rate |
$414.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$284.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$258.75
|
Rate for Payer: Aetna Government |
$258.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$414.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$351.90
|
Rate for Payer: Group Health Inc Commercial |
$258.75
|
Rate for Payer: Group Health Inc Medicare |
$181.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$258.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$258.75
|
|
ARTHRX 2.5MM DRILL BIT, CALIBRAT
|
Facility
IP
|
$85.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201575
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$42.50 |
Max. Negotiated Rate |
$42.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$42.50
|
|
ARTHRX 2.5MM DRILL BIT, CALIBRAT
|
Facility
OP
|
$85.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201575
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$29.75 |
Max. Negotiated Rate |
$134.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.75
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.88
|
Rate for Payer: Fidelis Medicare Advantage |
$89.25
|
Rate for Payer: Group Health Inc Commercial |
$42.50
|
Rate for Payer: Group Health Inc Medicare |
$29.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$42.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.25
|
|
ARTH SUT SD 25 DEG CURVE LT
|
Facility
OP
|
$400.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008263
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$420.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$220.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.00
|
Rate for Payer: Fidelis Medicare Advantage |
$420.00
|
Rate for Payer: Group Health Inc Commercial |
$200.00
|
Rate for Payer: Group Health Inc Medicare |
$140.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.00
|
|
ARTH SUT SD 25 DEG CURVE LT
|
Facility
IP
|
$400.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40008263
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$200.00 |
Max. Negotiated Rate |
$200.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
|
ARTHX LOCKNG LATRAL HOOK PLT 3H
|
Facility
OP
|
$700.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201578
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$735.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$350.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$402.50
|
Rate for Payer: Fidelis Medicare Advantage |
$735.00
|
Rate for Payer: Group Health Inc Commercial |
$350.00
|
Rate for Payer: Group Health Inc Medicare |
$245.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$455.00
|
|
ARTHX LOCKNG LATRAL HOOK PLT 3H
|
Facility
IP
|
$700.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201578
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$350.00 |
Max. Negotiated Rate |
$350.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
ARTHX LOCKNG MEDIAL HOOK PLT 3H
|
Facility
IP
|
$825.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201574
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$412.50 |
Max. Negotiated Rate |
$412.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$412.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$412.50
|
|
ARTHX LOCKNG MEDIAL HOOK PLT 3H
|
Facility
OP
|
$825.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201574
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$866.25 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$453.75
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$412.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$474.38
|
Rate for Payer: Fidelis Medicare Advantage |
$866.25
|
Rate for Payer: Group Health Inc Commercial |
$412.50
|
Rate for Payer: Group Health Inc Medicare |
$288.75
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$412.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$412.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$536.25
|
|
ARTIC SURGACE CRUCIATE RETAINING
|
Facility
IP
|
$2,393.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40200248
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,196.80 |
Max. Negotiated Rate |
$1,196.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,196.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,196.80
|
|
ARTIC SURGACE CRUCIATE RETAINING
|
Facility
OP
|
$2,393.60
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40200248
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,513.28 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,316.48
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,196.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,376.32
|
Rate for Payer: Fidelis Medicare Advantage |
$2,513.28
|
Rate for Payer: Group Health Inc Commercial |
$1,196.80
|
Rate for Payer: Group Health Inc Medicare |
$837.76
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,196.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,196.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,555.84
|
|
ARTICULAR SURGACE CR GREEN C-H
|
Facility
OP
|
$3,354.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202088
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$3,521.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,844.76
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,677.05
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,928.61
|
Rate for Payer: Fidelis Medicare Advantage |
$3,521.80
|
Rate for Payer: Group Health Inc Commercial |
$1,677.05
|
Rate for Payer: Group Health Inc Medicare |
$1,173.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,677.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,677.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,180.16
|
|
ARTICULAR SURGACE CR GREEN C-H
|
Facility
IP
|
$3,354.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40202088
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,677.05 |
Max. Negotiated Rate |
$1,677.05 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,677.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,677.05
|
|
ARTICULAR SURGACE CR YELLOW C-H
|
Facility
OP
|
$3,354.10
|
|
Hospital Charge Code |
40202091
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$1,173.94 |
Max. Negotiated Rate |
$2,683.28 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,844.76
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,677.05
|
Rate for Payer: Aetna Government |
$1,677.05
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,683.28
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,280.79
|
Rate for Payer: Group Health Inc Commercial |
$1,677.05
|
Rate for Payer: Group Health Inc Medicare |
$1,173.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,677.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,677.05
|
|
ARTICUL/EZE BALL 28
|
Facility
IP
|
$2,957.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903612
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,478.75 |
Max. Negotiated Rate |
$1,478.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,478.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,478.75
|
|
ARTICUL/EZE BALL 28
|
Facility
OP
|
$2,957.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64903612
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,105.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,626.62
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,478.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,700.56
|
Rate for Payer: Fidelis Medicare Advantage |
$3,105.38
|
Rate for Payer: Group Health Inc Commercial |
$1,478.75
|
Rate for Payer: Group Health Inc Medicare |
$1,035.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,478.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,478.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,922.38
|
|
ARTICUL/EZE BALL 28 5 BR
|
Facility
OP
|
$2,402.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40005146
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$339.17 |
Max. Negotiated Rate |
$2,522.10 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,321.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
Rate for Payer: Aetna Government |
$339.17
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,201.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,381.15
|
Rate for Payer: Fidelis Medicare Advantage |
$2,522.10
|
Rate for Payer: Group Health Inc Commercial |
$1,201.00
|
Rate for Payer: Group Health Inc Medicare |
$840.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,201.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,201.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,561.30
|
|
ARTICUL/EZE BALL 28 5 BR
|
Facility
OP
|
$3,002.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905205
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$3,152.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,651.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,501.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,726.44
|
Rate for Payer: Fidelis Medicare Advantage |
$3,152.62
|
Rate for Payer: Group Health Inc Commercial |
$1,501.25
|
Rate for Payer: Group Health Inc Medicare |
$1,050.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,501.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,501.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,951.62
|
|
ARTICUL/EZE BALL 28 5 BR
|
Facility
IP
|
$3,002.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
64905205
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,501.25 |
Max. Negotiated Rate |
$1,501.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,501.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,501.25
|
|
ARTICUL/EZE BALL 28 5 BR
|
Facility
IP
|
$2,402.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40005146
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,201.00 |
Max. Negotiated Rate |
$1,201.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,201.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,201.00
|
|
ARTIFICIAL TEARS 1.4% OPHTHALMIC SOLN
|
Facility
OP
|
$3.00
|
|
Hospital Charge Code |
41650165
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
Rate for Payer: Aetna Government |
$1.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
Rate for Payer: Group Health Inc Commercial |
$1.50
|
Rate for Payer: Group Health Inc Medicare |
$1.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
ARTIFICIAL TEARS 1.4% OPHTHALMIC SOLN
|
Facility
OP
|
$3.00
|
|
Hospital Charge Code |
41640165
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
Rate for Payer: Aetna Government |
$1.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
Rate for Payer: Group Health Inc Commercial |
$1.50
|
Rate for Payer: Group Health Inc Medicare |
$1.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
ART SPBDG IMP SYS BIOCOM4.75X19.1
|
Facility
IP
|
$1,740.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201460
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$870.00 |
Max. Negotiated Rate |
$870.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$870.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$870.00
|
|
ART SPBDG IMP SYS BIOCOM4.75X19.1
|
Facility
OP
|
$1,740.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40201460
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,827.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$957.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$870.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.50
|
Rate for Payer: Fidelis Medicare Advantage |
$1,827.00
|
Rate for Payer: Group Health Inc Commercial |
$870.00
|
Rate for Payer: Group Health Inc Medicare |
$609.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$870.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$870.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,131.00
|
|