|
SLEEVE UNITRAX V40 )MM STD
|
Facility
IP
|
$603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.50 |
| Max. Negotiated Rate |
$301.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.50
|
|
|
SLIDE HEMOCULT/SERACULT
|
Facility
OP
|
$1.03
|
|
| Hospital Charge Code |
64901887
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.52
|
| Rate for Payer: Aetna Government |
$0.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.70
|
| Rate for Payer: Group Health Inc Commercial |
$0.52
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.52
|
|
|
SLIDE MICRO FROSTED
|
Facility
OP
|
$1.94
|
|
| Hospital Charge Code |
64901296
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
| Rate for Payer: Aetna Government |
$0.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.32
|
| Rate for Payer: Group Health Inc Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
|
|
SLIDE MICRO MAILER
|
Facility
OP
|
$2.77
|
|
| Hospital Charge Code |
64901926
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.38
|
| Rate for Payer: Aetna Government |
$1.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.88
|
| Rate for Payer: Group Health Inc Commercial |
$1.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.38
|
|
|
SLIMLINE EZ 365MM
|
Facility
OP
|
$847.08
|
|
| Hospital Charge Code |
64904460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$296.48 |
| Max. Negotiated Rate |
$677.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$465.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$423.54
|
| Rate for Payer: Aetna Government |
$423.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$677.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$576.01
|
| Rate for Payer: Group Health Inc Commercial |
$423.54
|
| Rate for Payer: Group Health Inc Medicare |
$296.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$423.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$423.54
|
|
|
SLIMLINE EZ LASER FIBER-365
|
Facility
OP
|
$2,140.00
|
|
| Hospital Charge Code |
40201001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$749.00 |
| Max. Negotiated Rate |
$1,712.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,177.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,070.00
|
| Rate for Payer: Aetna Government |
$1,070.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,712.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,455.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,070.00
|
| Rate for Payer: Group Health Inc Medicare |
$749.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,070.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,070.00
|
|
|
SLING ADVANT-FIT TRASNVAG SYST
|
Facility
OP
|
$606.38
|
|
| Hospital Charge Code |
64904834
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$212.23 |
| Max. Negotiated Rate |
$485.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$333.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$303.19
|
| Rate for Payer: Aetna Government |
$303.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$485.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$412.34
|
| Rate for Payer: Group Health Inc Commercial |
$303.19
|
| Rate for Payer: Group Health Inc Medicare |
$212.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.19
|
|
|
SLING-FEMALE STRESS INCONT
|
Facility
OP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 57288
|
| Hospital Charge Code |
40129502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$824.52 |
| Max. Negotiated Rate |
$6,468.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,751.94
|
| Rate for Payer: Aetna Government |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,751.94
|
| 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 |
$5,751.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$824.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,889.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,119.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,751.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,119.23
|
| Rate for Payer: Group Health Inc Commercial |
$5,751.94
|
| Rate for Payer: Group Health Inc Medicare |
$5,751.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,468.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,751.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$916.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,889.15
|
| Rate for Payer: Healthfirst QHP |
$5,751.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,751.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,751.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,601.55
|
| Rate for Payer: Wellcare Medicare |
$5,464.34
|
|
|
SLING-MALE INCONTINENCE
|
Facility
OP
|
$24,435.75
|
|
|
Service Code
|
HCPCS 53440
|
| Hospital Charge Code |
40129500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$810.88 |
| Max. Negotiated Rate |
$14,844.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14,844.80
|
| Rate for Payer: Aetna Government |
$14,844.80
|
| Rate for Payer: Cash Price |
$14,844.80
|
| Rate for Payer: Cash Price |
$14,844.80
|
| Rate for Payer: Cash Price |
$14,844.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14,844.80
|
| 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 |
$14,844.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$810.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12,618.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13,211.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,844.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13,211.87
|
| Rate for Payer: Group Health Inc Commercial |
$14,844.80
|
| Rate for Payer: Group Health Inc Medicare |
$14,844.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,217.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14,844.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$900.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,618.08
|
| Rate for Payer: Healthfirst QHP |
$14,844.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14,844.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,844.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11,875.84
|
| Rate for Payer: Wellcare Medicare |
$14,102.56
|
|
|
SLIPPER ADULT XLG BEIGE SS
|
Facility
OP
|
$1.56
|
|
| Hospital Charge Code |
64902119
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.78
|
|
|
SLIPPERS GREEN UNIVERSAL
|
Facility
OP
|
$2.49
|
|
| Hospital Charge Code |
64901875
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna Government |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.24
|
|
|
SLIPPERS MEDIUM
|
Facility
OP
|
$2.96
|
|
| Hospital Charge Code |
64901138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.01
|
| Rate for Payer: Group Health Inc Commercial |
$1.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.48
|
|
|
SLIPPERS TODDLER AQUA SZ.6.5-13
|
Facility
OP
|
$1.33
|
|
| Hospital Charge Code |
64901510
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
| Rate for Payer: Aetna Government |
$0.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
|
|
SLIPPERS YOUTH SZ.9-13 CRANBERRY
|
Facility
OP
|
$1.33
|
|
| Hospital Charge Code |
64901512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
| Rate for Payer: Aetna Government |
$0.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.67
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
|
|
SLIPPER TERRY RUBBER SOLE ADLT
|
Facility
OP
|
$8.72
|
|
| Hospital Charge Code |
64903396
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$6.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.36
|
| Rate for Payer: Aetna Government |
$4.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.93
|
| Rate for Payer: Group Health Inc Commercial |
$4.36
|
| Rate for Payer: Group Health Inc Medicare |
$3.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.36
|
|
|
SLIPPER TERRY RUBBER SOLE ADULT
|
Facility
OP
|
$8.74
|
|
| Hospital Charge Code |
64903393
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$6.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.37
|
| Rate for Payer: Aetna Government |
$4.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.94
|
| Rate for Payer: Group Health Inc Commercial |
$4.37
|
| Rate for Payer: Group Health Inc Medicare |
$3.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.37
|
|
|
SLITTING OF PREPUCE (EXCEPT NB)
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
30305923
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.13 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,355.42
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| 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 |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
SLITTING OF PREPUCE (EXCEPT NB)
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
30105923
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.13 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,355.42
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| 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 |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
SLOTTED MALLET
|
Facility
IP
|
$1,368.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.00 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$684.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$684.00
|
|
|
SLOTTED MALLET
|
Facility
OP
|
$1,368.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,436.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$752.40
|
| 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 |
$684.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,436.40
|
| Rate for Payer: Group Health Inc Commercial |
$684.00
|
| Rate for Payer: Group Health Inc Medicare |
$478.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$684.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$684.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$889.20
|
|
|
SLP STUDY, UNATTENDED
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95800 TC
|
| Hospital Charge Code |
30504505
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.17 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.17
|
| 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 |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.63
|
|
|
SLP STUDY, UNATTENDED
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95800 TC
|
| Hospital Charge Code |
30304505
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.17 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.17
|
| 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 |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.63
|
|
|
SM 32-34 A-C MAS KIT WH
|
Facility
OP
|
$74.88
|
|
| Hospital Charge Code |
64905841
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.44
|
| Rate for Payer: Aetna Government |
$37.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.92
|
| Rate for Payer: Group Health Inc Commercial |
$37.44
|
| Rate for Payer: Group Health Inc Medicare |
$26.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.44
|
|
|
SMALL BONE RECIP BLADE
|
Facility
OP
|
$58.30
|
|
| Hospital Charge Code |
64905703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$46.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.15
|
| Rate for Payer: Aetna Government |
$29.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39.64
|
| Rate for Payer: Group Health Inc Commercial |
$29.15
|
| Rate for Payer: Group Health Inc Medicare |
$20.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.15
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 44372
|
| Hospital Charge Code |
40014134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$257.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$257.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$286.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
