|
SARS-COV-2 COVID-19 SBH
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 87635
|
| Hospital Charge Code |
40614120
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.31
|
| Rate for Payer: Aetna Government |
$51.31
|
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$51.31
|
| Rate for Payer: EmblemHealth Commercial |
$51.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.67
|
| Rate for Payer: Group Health Inc Commercial |
$51.31
|
| Rate for Payer: Group Health Inc Medicare |
$51.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.31
|
| Rate for Payer: Healthfirst QHP |
$51.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.05
|
| Rate for Payer: Wellcare Medicare |
$46.18
|
|
|
SARS-COV-2 XP XPRESS COVID-19-SBH
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS U0003
|
| Hospital Charge Code |
40614110
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.00
|
| Rate for Payer: Aetna Government |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
|
|
SBRT DELIV PERFRACT,1/>LESION
|
Facility
OP
|
$5,356.20
|
|
|
Service Code
|
HCPCS 77373
|
| Hospital Charge Code |
66542948
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$4,284.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,945.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,063.47
|
| Rate for Payer: Aetna Government |
$2,063.47
|
| Rate for Payer: Cash Price |
$2,063.47
|
| Rate for Payer: Cash Price |
$2,063.47
|
| Rate for Payer: Cash Price |
$2,063.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,063.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,284.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,642.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,063.47
|
| Rate for Payer: EmblemHealth Commercial |
$2,063.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,063.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,063.47
|
| Rate for Payer: Group Health Inc Medicare |
$2,063.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,678.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,063.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,857.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,063.47
|
| Rate for Payer: Healthfirst QHP |
$2,063.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,063.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,063.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,650.78
|
| Rate for Payer: Wellcare Medicare |
$1,960.30
|
|
|
SBSQ PSYC COLLAB CARE MGMT
|
Facility
OP
|
$237.88
|
|
|
Service Code
|
HCPCS 99493
|
| Hospital Charge Code |
30300187
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$190.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.10
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$184.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
SC5B-9 LEVEL
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
40729815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.00
|
| Rate for Payer: Aetna Government |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.00
|
| Rate for Payer: EmblemHealth Commercial |
$12.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$12.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.00
|
| Rate for Payer: Healthfirst QHP |
$12.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.60
|
| Rate for Payer: Wellcare Medicare |
$10.80
|
|
|
SCAFFOLD, DERMAL PRIMATRX 8X8
|
Facility
OP
|
$7,331.25
|
|
| Hospital Charge Code |
64906173
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,565.94 |
| Max. Negotiated Rate |
$5,865.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,032.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,665.62
|
| Rate for Payer: Aetna Government |
$3,665.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,865.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,985.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,665.62
|
| Rate for Payer: Group Health Inc Medicare |
$2,565.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,665.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,665.62
|
|
|
SCALED DRILL 2.5 AO FITTING
|
Facility
OP
|
$1,197.50
|
|
| Hospital Charge Code |
64905596
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$419.12 |
| Max. Negotiated Rate |
$958.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$658.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$598.75
|
| Rate for Payer: Aetna Government |
$598.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$958.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$814.30
|
| Rate for Payer: Group Health Inc Commercial |
$598.75
|
| Rate for Payer: Group Health Inc Medicare |
$419.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$598.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$598.75
|
|
|
SCALE SPRING FLUID MEASURING
|
Facility
OP
|
$51.59
|
|
| Hospital Charge Code |
64902002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$41.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Government |
$25.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.08
|
| Rate for Payer: Group Health Inc Commercial |
$25.80
|
| Rate for Payer: Group Health Inc Medicare |
$18.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.80
|
|
|
SCALING
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 17360
|
| Hospital Charge Code |
40011310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$101.12 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SCALP CLIP DISPO
|
Facility
OP
|
$132.50
|
|
| Hospital Charge Code |
64904925
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.38 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.25
|
| Rate for Payer: Aetna Government |
$66.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.10
|
| Rate for Payer: Group Health Inc Commercial |
$66.25
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.25
|
|
|
SCALPEL,SAFETY,DISPO,STERILE 1
|
Facility
OP
|
$3.90
|
|
| Hospital Charge Code |
64902483
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.95
|
| Rate for Payer: Aetna Government |
$1.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.65
|
| Rate for Payer: Group Health Inc Commercial |
$1.95
|
| Rate for Payer: Group Health Inc Medicare |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.95
|
|
|
SCALPEL,SAFETY,DISPO,STERILE,1
|
Facility
OP
|
$3.90
|
|
| Hospital Charge Code |
64902374
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.95
|
| Rate for Payer: Aetna Government |
$1.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.65
|
| Rate for Payer: Group Health Inc Commercial |
$1.95
|
| Rate for Payer: Group Health Inc Medicare |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.95
|
|
|
SCALP VEIN INFUSION SET
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40205710
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
SCHISTOSOMA AB
|
Facility
OP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40728213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.01
|
| Rate for Payer: EmblemHealth Commercial |
$13.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.58
|
| Rate for Payer: Group Health Inc Commercial |
$13.01
|
| Rate for Payer: Group Health Inc Medicare |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.01
|
| Rate for Payer: Healthfirst QHP |
$13.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.41
|
| Rate for Payer: Wellcare Medicare |
$11.71
|
|
|
SCHISTOSOMA IGG ANTIBODY
|
Facility
OP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40729368
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.01
|
| Rate for Payer: EmblemHealth Commercial |
$13.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.58
|
| Rate for Payer: Group Health Inc Commercial |
$13.01
|
| Rate for Payer: Group Health Inc Medicare |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.01
|
| Rate for Payer: Healthfirst QHP |
$13.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.41
|
| Rate for Payer: Wellcare Medicare |
$11.71
|
|
|
SCIATIC NERVE,CONT INFUS
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64446
|
| Hospital Charge Code |
30305039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.89 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
SCIATIC NERVE,SINGLE
|
Facility
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64445
|
| Hospital Charge Code |
30305034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.27 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| 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 |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
SCISSOR ENDO 5MM
|
Facility
OP
|
$162.50
|
|
| Hospital Charge Code |
64903091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.88 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.25
|
| Rate for Payer: Aetna Government |
$81.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$110.50
|
| Rate for Payer: Group Health Inc Commercial |
$81.25
|
| Rate for Payer: Group Health Inc Medicare |
$56.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.25
|
|
|
SCISSOR ENDO 5MM #5DCS
|
Facility
OP
|
$902.00
|
|
| Hospital Charge Code |
40200442
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$315.70 |
| Max. Negotiated Rate |
$721.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$496.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$451.00
|
| Rate for Payer: Aetna Government |
$451.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$721.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$613.36
|
| Rate for Payer: Group Health Inc Commercial |
$451.00
|
| Rate for Payer: Group Health Inc Medicare |
$315.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$451.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$451.00
|
|
|
SCISSOR MAYO STR 6
|
Facility
OP
|
$25.53
|
|
| Hospital Charge Code |
64903525
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.76
|
| Rate for Payer: Aetna Government |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.36
|
| Rate for Payer: Group Health Inc Commercial |
$12.76
|
| Rate for Payer: Group Health Inc Medicare |
$8.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.76
|
|
|
SCISSORS BAND LISTER LG RING
|
Facility
OP
|
$39.34
|
|
| Hospital Charge Code |
40200460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$31.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.67
|
| Rate for Payer: Aetna Government |
$19.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.75
|
| Rate for Payer: Group Health Inc Commercial |
$19.67
|
| Rate for Payer: Group Health Inc Medicare |
$13.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.67
|
|
|
SCISSORS ENDOPATH CURVED REPROC
|
Facility
OP
|
$388.80
|
|
| Hospital Charge Code |
64905437
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$194.40
|
| Rate for Payer: Aetna Government |
$194.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$311.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$264.38
|
| Rate for Payer: Group Health Inc Commercial |
$194.40
|
| Rate for Payer: Group Health Inc Medicare |
$136.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.40
|
|
|
SCISSORS MAYO CVD 6-3/4
|
Facility
OP
|
$59.38
|
|
| Hospital Charge Code |
40200461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.78 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.69
|
| Rate for Payer: Aetna Government |
$29.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.38
|
| Rate for Payer: Group Health Inc Commercial |
$29.69
|
| Rate for Payer: Group Health Inc Medicare |
$20.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.69
|
|
|
SCISSORS MAYO STR 6-3/4
|
Facility
OP
|
$55.14
|
|
| Hospital Charge Code |
40200462
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.30 |
| Max. Negotiated Rate |
$44.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.57
|
| Rate for Payer: Aetna Government |
$27.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.50
|
| Rate for Payer: Group Health Inc Commercial |
$27.57
|
| Rate for Payer: Group Health Inc Medicare |
$19.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.57
|
|
|
SCISSORS SUTURE WIRE ANGLED4-3/4
|
Facility
OP
|
$150.00
|
|
| Hospital Charge Code |
40200463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.00
|
| Rate for Payer: Aetna Government |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.00
|
| Rate for Payer: Group Health Inc Commercial |
$75.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.00
|
|
