|
SHELL OSSEO 4HOLE 56MM SZ F
|
Facility
OP
|
$3,800.00
|
|
| Hospital Charge Code |
64906849
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,330.00 |
| Max. Negotiated Rate |
$3,040.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,090.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,900.00
|
| Rate for Payer: Aetna Government |
$1,900.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,040.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,584.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,900.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,900.00
|
|
|
SHELL OSSEO 4HOLE 58MM G
|
Facility
OP
|
$3,800.00
|
|
| Hospital Charge Code |
64906852
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,330.00 |
| Max. Negotiated Rate |
$3,040.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,090.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,900.00
|
| Rate for Payer: Aetna Government |
$1,900.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,040.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,584.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,900.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,900.00
|
|
|
SHELL OSSEO G7 54MM COMP
|
Facility
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,900.00
|
|
|
SHELL OSSEO G7 54MM COMP
|
Facility
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,090.00
|
| 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 |
$1,900.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,185.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,990.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,900.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,900.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,470.00
|
|
|
SHELL R-HOLE SHELL 58 LL
|
Facility
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,900.00 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,900.00
|
|
|
SHELL R-HOLE SHELL 58 LL
|
Facility
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906546
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,990.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,090.00
|
| 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 |
$1,900.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,185.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,990.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,900.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,900.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,900.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,470.00
|
|
|
SHIELD SPLASH
|
Facility
OP
|
$2.78
|
|
| Hospital Charge Code |
40200623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.39
|
| Rate for Payer: Aetna Government |
$1.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.89
|
| Rate for Payer: Group Health Inc Commercial |
$1.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.39
|
|
|
SHIELD, SPLASH ZEROWET
|
Facility
OP
|
$347.65
|
|
| Hospital Charge Code |
64903186
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$278.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$173.82
|
| Rate for Payer: Aetna Government |
$173.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.40
|
| Rate for Payer: Group Health Inc Commercial |
$173.82
|
| Rate for Payer: Group Health Inc Medicare |
$121.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.82
|
|
|
SHILEY CATHETER
|
Facility
OP
|
$80.44
|
|
| Hospital Charge Code |
40207001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.22
|
| Rate for Payer: Aetna Government |
$40.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.70
|
| Rate for Payer: Group Health Inc Commercial |
$40.22
|
| Rate for Payer: Group Health Inc Medicare |
$28.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.22
|
|
|
Shiley Tracheotomy Tube
|
Facility
OP
|
$297.68
|
|
| Hospital Charge Code |
40205718
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.19 |
| Max. Negotiated Rate |
$238.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$148.84
|
| Rate for Payer: Aetna Government |
$148.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$238.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$202.42
|
| Rate for Payer: Group Health Inc Commercial |
$148.84
|
| Rate for Payer: Group Health Inc Medicare |
$104.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.84
|
|
|
SHILEY TUBE TRACH 4LPC CUFF LOW P
|
Facility
OP
|
$55.20
|
|
| Hospital Charge Code |
40205146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.60
|
| Rate for Payer: Aetna Government |
$27.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.54
|
| Rate for Payer: Group Health Inc Commercial |
$27.60
|
| Rate for Payer: Group Health Inc Medicare |
$19.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.60
|
|
|
SHIRT LNG SLEEVE NAVY STYLE 101
|
Facility
OP
|
$49.97
|
|
| Hospital Charge Code |
64902978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$39.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.98
|
| Rate for Payer: Aetna Government |
$24.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.98
|
| Rate for Payer: Group Health Inc Commercial |
$24.98
|
| Rate for Payer: Group Health Inc Medicare |
$17.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.98
|
|
|
SHO ARTHRS SRG CAPSULORPAPHY
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
40029937
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,199.02 |
| Max. Negotiated Rate |
$9,058.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,199.02
|
| 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 |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,332.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$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
|
|
|
SHO ARTHRS SRG COMPL SYNVCT
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29821
|
| Hospital Charge Code |
40029913
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$675.92 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$675.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$751.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SHO ARTHRS SRG DECOMPRESSION
|
Facility
OP
|
$2,065.55
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
40024213
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Government |
$182.32
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.99
|
| Rate for Payer: Group Health Inc Commercial |
$1,032.78
|
| Rate for Payer: Group Health Inc Medicare |
$722.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,032.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,032.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.54
|
|
|
SHO ARTHRS SRG DSTL CLAVICLC
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
40024268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$770.19 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$770.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$855.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SHO ARTHRS SRG LMTD DBRDMT
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29822
|
| Hospital Charge Code |
40029938
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$615.60 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$615.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$684.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SHO ARTHRS SRG LSS&RESCJ ADS
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29825
|
| Hospital Charge Code |
40029914
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$667.63 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$741.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SHO ARTHRS SRG PRTL SYNVCT
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29820
|
| Hospital Charge Code |
40029427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$605.87 |
| Max. Negotiated Rate |
$9,058.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$605.87
|
| 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 |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$673.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$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
|
|
|
SHO ARTHRS SRG RMVL LOOSE/FB
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29819
|
| Hospital Charge Code |
40023191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$667.63 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$741.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SHO ARTHRS SRG RT8TR CUF RPR
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
40024214
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,211.05 |
| Max. Negotiated Rate |
$9,058.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,211.05
|
| 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 |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,345.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$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
|
|
|
SHO ARTHRS SRG XTNSV DBRDMT
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
40024212
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$674.38 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$674.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$749.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SHOE POST-OP MEN SMALL
|
Facility
OP
|
$13.75
|
|
| Hospital Charge Code |
64901248
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.35
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
|
|
SHOE,POST OP,SEMI R,MEN,LG
|
Facility
OP
|
$13.75
|
|
| Hospital Charge Code |
64901274
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.35
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
|
|
SHOE,POST OP,SEMI R,MEN,MD
|
Facility
OP
|
$13.75
|
|
| Hospital Charge Code |
64901211
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.35
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
|
