|
SMARTLOCK HMMF PLATE SM
|
Facility
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903291
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$866.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$453.75
|
| 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 |
$412.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$474.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$866.25
|
| Rate for Payer: Group Health Inc Commercial |
$412.50
|
| Rate for Payer: Group Health Inc Medicare |
$288.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$412.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$412.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$536.25
|
|
|
SMARTLOCK HMMF PLATE SMALL
|
Facility
IP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.00
|
|
|
SMARTLOCK HMMF PLATE SMALL
|
Facility
OP
|
$660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203405
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$363.00
|
| 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 |
$330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$379.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$693.00
|
| Rate for Payer: Group Health Inc Commercial |
$330.00
|
| Rate for Payer: Group Health Inc Medicare |
$231.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$429.00
|
|
|
SMEAR FLUORESCENT/ACID STAI
|
Facility
OP
|
$13.48
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
40614332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.39
|
| Rate for Payer: Aetna Government |
$5.39
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Cash Price |
$5.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.39
|
| Rate for Payer: EmblemHealth Commercial |
$5.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.39
|
| Rate for Payer: Group Health Inc Medicare |
$5.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.39
|
| Rate for Payer: Healthfirst QHP |
$5.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.31
|
| Rate for Payer: Wellcare Medicare |
$4.85
|
|
|
SMEAR GRAM STAIN
|
Facility
OP
|
$10.68
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
40614331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$6.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.27
|
| Rate for Payer: EmblemHealth Commercial |
$4.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.27
|
| Rate for Payer: Healthfirst QHP |
$4.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.42
|
| Rate for Payer: Wellcare Medicare |
$3.84
|
|
|
SMEAR WET MOUNT SALINE/INK
|
Facility
OP
|
$14.52
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
40614333
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.82
|
| Rate for Payer: Aetna Government |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.82
|
| Rate for Payer: EmblemHealth Commercial |
$5.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.18
|
| Rate for Payer: Group Health Inc Commercial |
$5.82
|
| Rate for Payer: Group Health Inc Medicare |
$5.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.82
|
| Rate for Payer: Healthfirst QHP |
$5.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.66
|
| Rate for Payer: Wellcare Medicare |
$5.24
|
|
|
SMF PLT1.5MM TIT CRNL RGD MSH30MM
|
Facility
OP
|
$336.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$352.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$184.80
|
| 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 |
$168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$193.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$352.80
|
| Rate for Payer: Group Health Inc Commercial |
$168.00
|
| Rate for Payer: Group Health Inc Medicare |
$117.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.40
|
|
|
SMF PLT1.5MM TIT CRNL RGD MSH30MM
|
Facility
IP
|
$336.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202337
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.00
|
|
|
SMITH PETERSON NAIL
|
Facility
OP
|
$55.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.60
|
| 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 |
$27.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.42
|
| Rate for Payer: Group Health Inc Commercial |
$27.82
|
| Rate for Payer: Group Health Inc Medicare |
$19.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.17
|
|
|
SMITH PETERSON NAIL
|
Facility
IP
|
$55.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$27.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.82
|
|
|
SMITH TAC ABSOR. FIX. W/SPIKES
|
Facility
OP
|
$380.94
|
|
| Hospital Charge Code |
40203352
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$133.33 |
| Max. Negotiated Rate |
$304.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$209.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$190.47
|
| Rate for Payer: Aetna Government |
$190.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$304.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$259.04
|
| Rate for Payer: Group Health Inc Commercial |
$190.47
|
| Rate for Payer: Group Health Inc Medicare |
$133.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.47
|
|
|
SMITH TAC ABSOR. FIX. W/SPIKES
|
Facility
OP
|
$380.94
|
|
| Hospital Charge Code |
40009335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.33 |
| Max. Negotiated Rate |
$304.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$209.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$190.47
|
| Rate for Payer: Aetna Government |
$190.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$304.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$259.04
|
| Rate for Payer: Group Health Inc Commercial |
$190.47
|
| Rate for Payer: Group Health Inc Medicare |
$133.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.47
|
|
|
SMLL BONE SAW BLDE RECIP
|
Facility
OP
|
$58.30
|
|
| Hospital Charge Code |
64905360
|
|
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
|
|
|
SMOKING CC >THAN 10MINS
|
Facility
OP
|
$82.75
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
30301405
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| 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 |
$41.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
SMOKING CESSATION
|
Facility
OP
|
$82.75
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
42303458
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| 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 |
$41.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
SMOKING CESSATION > 10 MIN
|
Facility
OP
|
$82.75
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
42303459
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| 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 |
$41.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
SMOKING CESSATION CLASS
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
HCPCS S9453
|
| Hospital Charge Code |
30305715
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.43
|
| Rate for Payer: Aetna Government |
$9.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| 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 |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
|
|
SMOKING CESSATION COUNSELING
|
Facility
OP
|
$82.75
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
30300036
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| 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 |
$41.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
SMOKING CESSATION COUNSELING
|
Facility
OP
|
$82.75
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
30400036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| 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 |
$41.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
SMOKING CESSATION COUNSELING.
|
Facility
OP
|
$82.75
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
30400123
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| 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 |
$41.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
SMOOTH MUSCLE ANTIBODY T
|
Facility
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30303372
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$19.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
S.M.P. CATH SET ASH SPLIT 14FX28C
|
Facility
OP
|
$860.00
|
|
| Hospital Charge Code |
40203342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$688.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$473.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$430.00
|
| Rate for Payer: Aetna Government |
$430.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$688.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$584.80
|
| Rate for Payer: Group Health Inc Commercial |
$430.00
|
| Rate for Payer: Group Health Inc Medicare |
$301.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$430.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$430.00
|
|
|
S.M.P. CATH SET ASH SPLIT 14FX28C
|
Facility
OP
|
$860.00
|
|
| Hospital Charge Code |
40009324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$688.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$473.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$430.00
|
| Rate for Payer: Aetna Government |
$430.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$688.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$584.80
|
| Rate for Payer: Group Health Inc Commercial |
$430.00
|
| Rate for Payer: Group Health Inc Medicare |
$301.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$430.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$430.00
|
|
|
SNARE COLD ROUND
|
Facility
OP
|
$32.50
|
|
| Hospital Charge Code |
64906818
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.25
|
| Rate for Payer: Aetna Government |
$16.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.10
|
| Rate for Payer: Group Health Inc Commercial |
$16.25
|
| Rate for Payer: Group Health Inc Medicare |
$11.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.25
|
|
|
SNARE POLY 2.4MM MED OVAL
|
Facility
OP
|
$47.84
|
|
| Hospital Charge Code |
64906816
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.92
|
| Rate for Payer: Aetna Government |
$23.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.53
|
| Rate for Payer: Group Health Inc Commercial |
$23.92
|
| Rate for Payer: Group Health Inc Medicare |
$16.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.92
|
|
