|
SUPPORT KNEE NEOP 15-16 LARGE
|
Facility
OP
|
$62.23
|
|
| Hospital Charge Code |
64902842
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$49.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.12
|
| Rate for Payer: Aetna Government |
$31.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.32
|
| Rate for Payer: Group Health Inc Commercial |
$31.12
|
| Rate for Payer: Group Health Inc Medicare |
$21.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.12
|
|
|
SUPPORT KNEE NEOPR UNIV OPEN PAT
|
Facility
OP
|
$47.70
|
|
| Hospital Charge Code |
64902838
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.85
|
| Rate for Payer: Aetna Government |
$23.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.44
|
| Rate for Payer: Group Health Inc Commercial |
$23.85
|
| Rate for Payer: Group Health Inc Medicare |
$16.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.85
|
|
|
SUPRAPUBIC CYSTOSTOMY
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 51040
|
| Hospital Charge Code |
40123040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$316.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.04
|
| 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 |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| 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 |
$351.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$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
|
|
|
SUPRAPUBIC PROSTATECTOMY
|
Facility
OP
|
$2,881.78
|
|
|
Service Code
|
HCPCS 55821
|
| Hospital Charge Code |
40123075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.31 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,584.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,027.93
|
| Rate for Payer: Aetna Government |
$1,027.93
|
| 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 |
$901.31
|
| Rate for Payer: Group Health Inc Commercial |
$1,440.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,008.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,440.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,440.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,001.46
|
|
|
SUPRARENAL EXTENSION CUFF
|
Facility
OP
|
$5,590.00
|
|
| Hospital Charge Code |
40202228
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,956.50 |
| Max. Negotiated Rate |
$4,472.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,074.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,795.00
|
| Rate for Payer: Aetna Government |
$2,795.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,472.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,801.20
|
| Rate for Payer: Group Health Inc Commercial |
$2,795.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,956.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,795.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,795.00
|
|
|
SUREFIRE SCORPIAN NEEDLE
|
Facility
OP
|
$500.00
|
|
| Hospital Charge Code |
64902829
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.00
|
| Rate for Payer: Aetna Government |
$250.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
|
SURFACE CRUCIATE RET ARIC YEL
|
Facility
OP
|
$4,192.63
|
|
| Hospital Charge Code |
64904551
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,467.42 |
| Max. Negotiated Rate |
$3,354.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,305.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,096.32
|
| Rate for Payer: Aetna Government |
$2,096.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,354.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,850.99
|
| Rate for Payer: Group Health Inc Commercial |
$2,096.32
|
| Rate for Payer: Group Health Inc Medicare |
$1,467.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,096.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,096.32
|
|
|
SURFACE TIB ARTICULAT 11MM
|
Facility
OP
|
$3,658.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,840.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,011.90
|
| 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 |
$1,829.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,103.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,840.90
|
| Rate for Payer: Group Health Inc Commercial |
$1,829.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,280.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,829.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,829.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,377.70
|
|
|
SURFACE TIB ARTICULAT 11MM
|
Facility
IP
|
$3,658.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,829.00 |
| Max. Negotiated Rate |
$1,829.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,829.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,829.00
|
|
|
SURFACE TIBIAL ARTICULAR
|
Facility
IP
|
$3,048.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.00 |
| Max. Negotiated Rate |
$1,524.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,524.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,524.00
|
|
|
SURFACE TIBIAL ARTICULAR
|
Facility
OP
|
$3,048.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,200.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,676.40
|
| 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 |
$1,524.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,752.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,200.40
|
| Rate for Payer: Group Health Inc Commercial |
$1,524.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,066.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,524.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,524.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,981.20
|
|
|
SURFACTANT ADMIN THRU TUBE
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94610
|
| Hospital Charge Code |
30104002
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$58.51 |
| Max. Negotiated Rate |
$445.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$445.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
SURGCLIP PREM II M-11.5 TIT
|
Facility
OP
|
$266.18
|
|
| Hospital Charge Code |
40206023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.16 |
| Max. Negotiated Rate |
$212.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$146.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$133.09
|
| Rate for Payer: Aetna Government |
$133.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$212.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$181.00
|
| Rate for Payer: Group Health Inc Commercial |
$133.09
|
| Rate for Payer: Group Health Inc Medicare |
$93.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.09
|
|
|
SURGCLIP PREM TITANIUM
|
Facility
OP
|
$232.00
|
|
| Hospital Charge Code |
40206021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$185.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$127.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$116.00
|
| Rate for Payer: Aetna Government |
$116.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$185.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$157.76
|
| Rate for Payer: Group Health Inc Commercial |
$116.00
|
| Rate for Payer: Group Health Inc Medicare |
$81.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.00
|
|
|
SURG CONSULT W/FROZEN SECTION
|
Facility
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 88331
|
| Hospital Charge Code |
40635435
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$239.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Brighton Health Commercial |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
SURG CONSULT WITH FROZEN SECT
|
Facility
OP
|
$434.63
|
|
|
Service Code
|
HCPCS 88331
|
| Hospital Charge Code |
40635436
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$239.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$197.52
|
| Rate for Payer: Aetna Government |
$197.52
|
| Rate for Payer: Brighton Health Commercial |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Cash Price |
$197.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$197.52
|
| Rate for Payer: EmblemHealth Commercial |
$197.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.79
|
| Rate for Payer: Group Health Inc Commercial |
$197.52
|
| Rate for Payer: Group Health Inc Medicare |
$197.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$197.52
|
| Rate for Payer: Healthfirst QHP |
$197.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$158.02
|
| Rate for Payer: Wellcare Medicare |
$177.77
|
|
|
SURG CONSULT W/OUT FROZEN SECT
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 88329
|
| Hospital Charge Code |
40635430
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$70.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.74
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$63.67
|
|
|
SURG CONSULT W/OUT FROZEN SECT
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 88329
|
| Hospital Charge Code |
40635431
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$70.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.74
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$63.67
|
|
|
SURGERY FOR VAGINAL COLLAPSE
|
Facility
OP
|
$13,573.52
|
|
|
Service Code
|
HCPCS 57120
|
| Hospital Charge Code |
30101119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$6,786.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,751.94
|
| Rate for Payer: Aetna Government |
$5,751.94
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$5,751.94
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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 |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$593.96
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,786.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,751.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$5,751.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$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
|
|
|
SURGERY TO EXPLORE WOUND
|
Facility
OP
|
$1,915.52
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
30102046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,874.89
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$388.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| 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 |
$957.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
SURGERY TO REPAIR BROKEN WRIST
|
Facility
OP
|
$19,280.70
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
30301511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$941.46 |
| Max. Negotiated Rate |
$9,640.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| 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 |
$8,273.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$941.46
|
| 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 |
$9,640.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,046.07
|
| 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
|
|
|
SURG EXP-IMP/UNERUP TOOTH FOR ORT
|
Facility
OP
|
$725.00
|
|
|
Service Code
|
HCPCS D7280
|
| Hospital Charge Code |
42301705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$362.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$398.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$362.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SURG FIBRILLAR ABS
|
Facility
OP
|
$539.89
|
|
| Hospital Charge Code |
64905768
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$188.96 |
| Max. Negotiated Rate |
$431.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$296.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$269.94
|
| Rate for Payer: Aetna Government |
$269.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$431.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$367.13
|
| Rate for Payer: Group Health Inc Commercial |
$269.94
|
| Rate for Payer: Group Health Inc Medicare |
$188.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$269.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$269.94
|
|
|
SURGICAL 1/2 X 2
|
Facility
OP
|
$6.73
|
|
| Hospital Charge Code |
40205802
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
|
SURGICAL 2 X 14
|
Facility
OP
|
$18.78
|
|
| Hospital Charge Code |
40205814
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.39
|
| Rate for Payer: Aetna Government |
$9.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.77
|
| Rate for Payer: Group Health Inc Commercial |
$9.39
|
| Rate for Payer: Group Health Inc Medicare |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.39
|
|
