|
SET, THORACENTESIS
|
Facility
OP
|
$7.46
|
|
| Hospital Charge Code |
64901014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.73
|
| Rate for Payer: Aetna Government |
$3.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.07
|
| Rate for Payer: Group Health Inc Commercial |
$3.73
|
| Rate for Payer: Group Health Inc Medicare |
$2.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.73
|
|
|
SET TUBIND STD BORE 7.6 NDLESS
|
Facility
OP
|
$4.45
|
|
| Hospital Charge Code |
64902177
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.22
|
| Rate for Payer: Aetna Government |
$2.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.03
|
| Rate for Payer: Group Health Inc Commercial |
$2.22
|
| Rate for Payer: Group Health Inc Medicare |
$1.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.22
|
|
|
SET W/ PUMP SCROTAL 0 DEG CYL
|
Facility
OP
|
$19,500.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64902769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.00 |
| Max. Negotiated Rate |
$20,475.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,725.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9,750.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,212.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,475.00
|
| Rate for Payer: Group Health Inc Commercial |
$9,750.00
|
| Rate for Payer: Group Health Inc Medicare |
$6,825.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,750.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,675.00
|
|
|
SET W/ PUMP SCROTAL 0 DEG CYL
|
Facility
IP
|
$19,500.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64902769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,750.00 |
| Max. Negotiated Rate |
$9,750.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,750.00
|
|
|
SEVELAMER 400 MG TAB
|
Facility
OP
|
$3.06
|
|
| Hospital Charge Code |
41652634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.53
|
| Rate for Payer: Aetna Government |
$1.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.08
|
| Rate for Payer: Group Health Inc Commercial |
$1.53
|
| Rate for Payer: Group Health Inc Medicare |
$1.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.99
|
|
|
SEVELAMER 400 MG TAB
|
Facility
OP
|
$3.06
|
|
| Hospital Charge Code |
41642634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.53
|
| Rate for Payer: Aetna Government |
$1.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.08
|
| Rate for Payer: Group Health Inc Commercial |
$1.53
|
| Rate for Payer: Group Health Inc Medicare |
$1.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.99
|
|
|
SEVELAMER 800 MG TAB
|
Facility
OP
|
$6.12
|
|
| Hospital Charge Code |
41652646
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.06
|
| Rate for Payer: Aetna Government |
$3.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.16
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.98
|
|
|
SEVELAMER 800 MG TAB
|
Facility
OP
|
$6.12
|
|
| Hospital Charge Code |
41642646
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.06
|
| Rate for Payer: Aetna Government |
$3.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.16
|
| Rate for Payer: Group Health Inc Commercial |
$3.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.98
|
|
|
SEVELAMER CARBONATE 800MG TAB
|
Facility
OP
|
$1.15
|
|
| Hospital Charge Code |
41653892
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
SEVELAMER CARBONATE 800MG TAB
|
Facility
OP
|
$1.15
|
|
| Hospital Charge Code |
41643892
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
SEVELAMER CARBONATE POWDER
|
Facility
OP
|
$45.72
|
|
| Hospital Charge Code |
41640318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$36.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.86
|
| Rate for Payer: Aetna Government |
$22.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.09
|
| Rate for Payer: Group Health Inc Commercial |
$22.86
|
| Rate for Payer: Group Health Inc Medicare |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.72
|
|
|
SEVELAMER CARBONATE POWDER
|
Facility
OP
|
$45.72
|
|
| Hospital Charge Code |
41650318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$36.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.86
|
| Rate for Payer: Aetna Government |
$22.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.09
|
| Rate for Payer: Group Health Inc Commercial |
$22.86
|
| Rate for Payer: Group Health Inc Medicare |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.72
|
|
|
SEX HORM BINDING GLOB, SERUM
|
Facility
OP
|
$54.33
|
|
|
Service Code
|
HCPCS 84270
|
| Hospital Charge Code |
40609115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$34.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.73
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$19.56
|
|
|
SEX HORMONE BINDING GLOBULIN
|
Facility
OP
|
$54.33
|
|
|
Service Code
|
HCPCS 84270
|
| Hospital Charge Code |
40608232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$34.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.73
|
| Rate for Payer: Aetna Government |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.73
|
| Rate for Payer: EmblemHealth Commercial |
$21.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.34
|
| Rate for Payer: Group Health Inc Commercial |
$21.73
|
| Rate for Payer: Group Health Inc Medicare |
$21.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.73
|
| Rate for Payer: Healthfirst QHP |
$21.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.38
|
| Rate for Payer: Wellcare Medicare |
$19.56
|
|
|
SGOT,SGPT
|
Facility
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 84450
|
| Hospital Charge Code |
40602125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$8.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
SGPT
|
Facility
OP
|
$13.25
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
40602135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.30
|
| Rate for Payer: Aetna Government |
$5.30
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.30
|
| Rate for Payer: EmblemHealth Commercial |
$5.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.72
|
| Rate for Payer: Group Health Inc Commercial |
$5.30
|
| Rate for Payer: Group Health Inc Medicare |
$5.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.30
|
| Rate for Payer: Healthfirst QHP |
$5.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.24
|
| Rate for Payer: Wellcare Medicare |
$4.77
|
|
|
SGTRY SER POLYAX 6.5X45MM
|
Facility
IP
|
$4,665.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,332.79 |
| Max. Negotiated Rate |
$2,332.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,332.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,332.79
|
|
|
SGTRY SER POLYAX 6.5X45MM
|
Facility
OP
|
$4,665.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40008314
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,898.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,566.07
|
| 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 |
$2,332.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,682.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,898.86
|
| Rate for Payer: Group Health Inc Commercial |
$2,332.79
|
| Rate for Payer: Group Health Inc Medicare |
$1,632.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,332.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,332.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,032.63
|
|
|
SHAFT STIFF ANGLED .035 180CM
|
Facility
OP
|
$127.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.12
|
| 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 |
$63.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.88
|
| Rate for Payer: Group Health Inc Commercial |
$63.75
|
| Rate for Payer: Group Health Inc Medicare |
$44.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.88
|
|
|
SHAFT STIFF ANGLED .035 180CM
|
Facility
IP
|
$127.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.75
|
|
|
SHANK, SCREW RELINE 6.5X45MM 2
|
Facility
OP
|
$2,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,396.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,255.10
|
| 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 |
$1,141.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,312.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,396.10
|
| Rate for Payer: Group Health Inc Commercial |
$1,141.00
|
| Rate for Payer: Group Health Inc Medicare |
$798.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,141.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,141.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,483.30
|
|
|
SHANK, SCREW RELINE 6.5X45MM 2
|
Facility
IP
|
$2,282.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905584
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.00 |
| Max. Negotiated Rate |
$1,141.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,141.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,141.00
|
|
|
SHARP DEBRIDEMENT/ PULSED LAVAGE
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97597
|
| Hospital Charge Code |
41802198
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$291.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| 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 |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.52
|
| 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 |
$120.00
|
| 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 |
$41.28
|
| 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 |
$55.00
|
|
|
SHAVE LES,S/N/H/F/G,1.1-2.0
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11307
|
| Hospital Charge Code |
42201718
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.05 |
| 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: Brighton Health Commercial |
$233.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$67.05
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$74.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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
|
|
|
SHAVE LES, S/N/H/F/G, > 2.0CM
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 11308
|
| Hospital Charge Code |
42201736
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
