|
SHOE,POST OP,VINYL,H&L,M
|
Facility
OP
|
$8.85
|
|
| Hospital Charge Code |
64901774
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE,POST OP,VINYL,H&L,MEN
|
Facility
OP
|
$8.85
|
|
| Hospital Charge Code |
64901761
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE,POST OP,VINYL,MEN,SM
|
Facility
OP
|
$8.86
|
|
| Hospital Charge Code |
64901758
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.43
|
| Rate for Payer: Aetna Government |
$4.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.43
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.43
|
|
|
SHOE,POST OP,VINYL,WOMEN,LG
|
Facility
OP
|
$8.85
|
|
| Hospital Charge Code |
64901782
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE,POST OP,VINYL,WOMEN,MED
|
Facility
OP
|
$8.85
|
|
| Hospital Charge Code |
64901779
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE,POST OP,VINYL,WOMEN,SM
|
Facility
OP
|
$8.85
|
|
| Hospital Charge Code |
64901776
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.02
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
|
|
SHOE, ROCKER MED
|
Facility
OP
|
$4,158.00
|
|
| Hospital Charge Code |
64907389
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,455.30 |
| Max. Negotiated Rate |
$3,326.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,079.00
|
| Rate for Payer: Aetna Government |
$2,079.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,326.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,827.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,079.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,079.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,079.00
|
|
|
SHORT LEG CAST
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
30105936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$310.57
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.57
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$295.04
|
|
|
SHORT LEG CAST
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29405
|
| Hospital Charge Code |
30305936
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.52 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$310.57
|
| Rate for Payer: Aetna Government |
$310.57
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$310.57
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Cash Price |
$310.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$310.57
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.41
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$310.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$248.46
|
| Rate for Payer: Wellcare Medicare |
$295.04
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC
|
Facility
IP
|
$35,676.16
|
|
|
Service Code
|
MS-DRG 511
|
| Min. Negotiated Rate |
$16,264.13 |
| Max. Negotiated Rate |
$35,676.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,398.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,976.63
|
| Rate for Payer: Aetna Government |
$34,976.63
|
| Rate for Payer: Brighton Health Commercial |
$28,910.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,676.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,430.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,413.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,227.80
|
| Rate for Payer: EmblemHealth Commercial |
$17,096.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,976.63
|
| Rate for Payer: Group Health Inc Commercial |
$34,976.63
|
| Rate for Payer: Group Health Inc Medicare |
$34,976.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,976.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,264.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,976.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,976.63
|
| Rate for Payer: Wellcare Medicare |
$33,227.80
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC
|
Facility
IP
|
$46,982.04
|
|
|
Service Code
|
MS-DRG 510
|
| Min. Negotiated Rate |
$20,950.79 |
| Max. Negotiated Rate |
$46,982.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40,115.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45,055.46
|
| Rate for Payer: Aetna Government |
$45,055.46
|
| Rate for Payer: Brighton Health Commercial |
$39,448.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45,956.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46,982.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38,771.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$42,802.69
|
| Rate for Payer: EmblemHealth Commercial |
$23,329.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$45,055.46
|
| Rate for Payer: Group Health Inc Commercial |
$45,055.46
|
| Rate for Payer: Group Health Inc Medicare |
$45,055.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45,055.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20,950.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45,055.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45,055.46
|
| Rate for Payer: Wellcare Medicare |
$42,802.69
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$30,301.16
|
|
|
Service Code
|
MS-DRG 512
|
| Min. Negotiated Rate |
$13,813.76 |
| Max. Negotiated Rate |
$30,301.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,795.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,707.02
|
| Rate for Payer: Aetna Government |
$29,707.02
|
| Rate for Payer: Brighton Health Commercial |
$23,400.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,301.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,868.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,998.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,221.67
|
| Rate for Payer: EmblemHealth Commercial |
$13,838.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,707.02
|
| Rate for Payer: Group Health Inc Commercial |
$29,707.02
|
| Rate for Payer: Group Health Inc Medicare |
$29,707.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,707.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,813.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,707.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,707.02
|
| Rate for Payer: Wellcare Medicare |
$28,221.67
|
|
|
SHOULDER HUM TRY =0 40MM STD
|
Facility
OP
|
$2,715.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,850.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,493.25
|
| 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 |
$1,357.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,561.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,850.75
|
| Rate for Payer: Group Health Inc Commercial |
$1,357.50
|
| Rate for Payer: Group Health Inc Medicare |
$950.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,357.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,357.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,764.75
|
|
|
SHOULDER HUM TRY =0 40MM STD
|
Facility
IP
|
$2,715.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,357.50 |
| Max. Negotiated Rate |
$1,357.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,357.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,357.50
|
|
|
Shoulder Immobilizer
|
Facility
OP
|
$99.94
|
|
| Hospital Charge Code |
40205717
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$79.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.97
|
| Rate for Payer: Aetna Government |
$49.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.96
|
| Rate for Payer: Group Health Inc Commercial |
$49.97
|
| Rate for Payer: Group Health Inc Medicare |
$34.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.97
|
|
|
SHOULDER IMPLANT
|
Facility
OP
|
$4,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,013.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,626.25
|
| 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 |
$2,387.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,745.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,013.75
|
| Rate for Payer: Group Health Inc Commercial |
$2,387.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,671.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,387.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,387.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,103.75
|
|
|
SHOULDER IMPLANT
|
Facility
IP
|
$4,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907359
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,387.50 |
| Max. Negotiated Rate |
$2,387.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,387.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,387.50
|
|
|
SHOULDER REPL
|
Facility
OP
|
$5,187.06
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
40000530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$22,108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,108.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,551.15
|
| Rate for Payer: Aetna Government |
$21,551.15
|
| Rate for Payer: Cash Price |
$21,551.15
|
| Rate for Payer: Cash Price |
$21,551.15
|
| Rate for Payer: Cash Price |
$21,551.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,551.15
|
| 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 |
$21,551.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,634.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18,318.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19,180.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,551.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19,180.52
|
| Rate for Payer: Group Health Inc Commercial |
$21,551.15
|
| Rate for Payer: Group Health Inc Medicare |
$21,551.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,593.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,551.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,815.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,318.48
|
| Rate for Payer: Healthfirst QHP |
$21,551.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,551.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,551.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17,240.92
|
| Rate for Payer: Wellcare Medicare |
$20,473.59
|
|
|
SHUNT BYPASS CAROTID 12FR ST 13CM
|
Facility
OP
|
$361.00
|
|
| Hospital Charge Code |
40200983
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.35 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$198.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.50
|
| Rate for Payer: Aetna Government |
$180.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$288.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$245.48
|
| Rate for Payer: Group Health Inc Commercial |
$180.50
|
| Rate for Payer: Group Health Inc Medicare |
$126.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.50
|
|
|
SHUNT CAROTID
|
Facility
OP
|
$1,346.63
|
|
| Hospital Charge Code |
64907142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$471.32 |
| Max. Negotiated Rate |
$1,077.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$740.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$673.32
|
| Rate for Payer: Aetna Government |
$673.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,077.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$915.71
|
| Rate for Payer: Group Health Inc Commercial |
$673.32
|
| Rate for Payer: Group Health Inc Medicare |
$471.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$673.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$673.32
|
|
|
SHUTTLE SHEATH 90CM
|
Facility
OP
|
$250.00
|
|
| Hospital Charge Code |
64905928
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.00
|
| Rate for Payer: Aetna Government |
$125.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
SIALODOCHOPLASTY
|
Facility
OP
|
$2,065.00
|
|
|
Service Code
|
HCPCS D7982
|
| Hospital Charge Code |
42302145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$547.61 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,135.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$547.61
|
| Rate for Payer: Aetna Government |
$547.61
|
| 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: Group Health Inc Commercial |
$1,032.50
|
| Rate for Payer: Group Health Inc Medicare |
$722.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,032.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,032.50
|
|
|
SIALOGRAPHY
|
Facility
OP
|
$102.50
|
|
|
Service Code
|
HCPCS D0310
|
| Hospital Charge Code |
42300165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| 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 |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
SIALOLITHOTOMY
|
Facility
OP
|
$725.00
|
|
|
Service Code
|
HCPCS D7980
|
| Hospital Charge Code |
42302135
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$231.13 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$398.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.13
|
| Rate for Payer: Aetna Government |
$231.13
|
| 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: Group Health Inc Commercial |
$362.50
|
| Rate for Payer: Group Health Inc Medicare |
$253.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$362.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.50
|
|
|
SICKLE CELL SC FEE
|
Facility
OP
|
$32.18
|
|
|
Service Code
|
HCPCS 83020
|
| Hospital Charge Code |
40701196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.87
|
| Rate for Payer: Aetna Government |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.87
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.87
|
| Rate for Payer: Group Health Inc Medicare |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$12.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
|
