|
SURGICAL 2 X 3
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40205803
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
SURGICAL 4 X 8
|
Facility
OP
|
$25.52
|
|
| Hospital Charge Code |
40205808
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$20.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.76
|
| Rate for Payer: Aetna Government |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.35
|
| Rate for Payer: Group Health Inc Commercial |
$12.76
|
| Rate for Payer: Group Health Inc Medicare |
$8.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.76
|
|
|
SURGICAL DISCECTOMY WITH/WITHOUT
|
Facility
OP
|
$2,175.00
|
|
|
Service Code
|
HCPCS D7850
|
| Hospital Charge Code |
42301960
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$761.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,196.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,557.25
|
| Rate for Payer: Aetna Government |
$1,557.25
|
| 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 |
$1,087.50
|
| Rate for Payer: Group Health Inc Medicare |
$761.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,087.50
|
|
|
SURGICAL IMPLANT
|
Facility
OP
|
$2,500.00
|
|
| Hospital Charge Code |
40203231
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,375.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,250.00
|
| Rate for Payer: Aetna Government |
$1,250.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,700.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
|
|
SURGICAL PATHOLOGY GROSS EXM ONLY
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 88300
|
| Hospital Charge Code |
40635411
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Brighton Health Commercial |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.64
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$34.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
SURGICAL PREP OF SITE
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 15002
|
| Hospital Charge Code |
42500134
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: EmblemHealth Commercial |
$2,108.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| Rate for Payer: Group Health Inc Commercial |
$2,108.87
|
| Rate for Payer: Group Health Inc Medicare |
$2,108.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
SURGICAL REPOSITIONING OF TEETH
|
Facility
OP
|
$362.50
|
|
|
Service Code
|
HCPCS D7290
|
| Hospital Charge Code |
42301725
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.12
|
| Rate for Payer: Aetna Government |
$110.12
|
| Rate for Payer: Amida Care Medicaid |
$97.60
|
| 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: Fidelis CHP/HARP/Medicaid |
$9,760.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.48
|
| Rate for Payer: Group Health Inc Commercial |
$181.25
|
| Rate for Payer: Group Health Inc Medicare |
$126.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.60
|
| Rate for Payer: Healthfirst Essential Plan |
$219.60
|
| Rate for Payer: Healthfirst QHP |
$97.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.60
|
| Rate for Payer: SOMOS Essential |
$219.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$97.60
|
|
|
SURGICAL SPLINT
|
Facility
OP
|
$1,066.00
|
|
|
Service Code
|
HCPCS D5988
|
| Hospital Charge Code |
42301405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$533.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$586.30
|
| 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 |
$533.00
|
| 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
|
|
|
SURGICAL STENT
|
Facility
OP
|
$666.00
|
|
|
Service Code
|
HCPCS D5982
|
| Hospital Charge Code |
42301375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$366.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.15
|
| Rate for Payer: Aetna Government |
$163.15
|
| 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: Group Health Inc Commercial |
$333.00
|
| Rate for Payer: Group Health Inc Medicare |
$233.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$333.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$333.00
|
|
|
SURGICAL SUPPLY 100-499
|
Facility
OP
|
$430.09
|
|
| Hospital Charge Code |
40203106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.53 |
| Max. Negotiated Rate |
$344.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$236.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$215.04
|
| Rate for Payer: Aetna Government |
$215.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$344.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$292.46
|
| Rate for Payer: Group Health Inc Commercial |
$215.04
|
| Rate for Payer: Group Health Inc Medicare |
$150.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$215.04
|
|
|
SURGICAL SUPPLY 500-1000
|
Facility
OP
|
$1,357.77
|
|
| Hospital Charge Code |
40203107
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$475.22 |
| Max. Negotiated Rate |
$1,086.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$746.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$678.88
|
| Rate for Payer: Aetna Government |
$678.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,086.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$923.28
|
| Rate for Payer: Group Health Inc Commercial |
$678.88
|
| Rate for Payer: Group Health Inc Medicare |
$475.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$678.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$678.88
|
|
|
Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric
|
Facility
OP
|
$3,246.99
|
|
|
Service Code
|
CPT 46275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$473.27 |
| Max. Negotiated Rate |
$3,246.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$473.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
Surgical treatment of anal fistula (fistulectomy/fistulotomy); second stage
|
Facility
OP
|
$3,246.99
|
|
|
Service Code
|
CPT 46285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.94 |
| Max. Negotiated Rate |
$3,246.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$472.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$525.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous
|
Facility
OP
|
$3,246.99
|
|
|
Service Code
|
CPT 46270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$453.74 |
| Max. Negotiated Rate |
$3,246.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$453.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$504.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed
|
Facility
OP
|
$3,246.99
|
|
|
Service Code
|
CPT 46280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$540.80 |
| Max. Negotiated Rate |
$3,246.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$540.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$600.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
SURGICLIP PREM II M-11.5 TIT
|
Facility
OP
|
$454.05
|
|
| Hospital Charge Code |
64904616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$158.92 |
| Max. Negotiated Rate |
$363.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$249.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$227.02
|
| Rate for Payer: Aetna Government |
$227.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$363.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$308.75
|
| Rate for Payer: Group Health Inc Commercial |
$227.02
|
| Rate for Payer: Group Health Inc Medicare |
$158.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.02
|
|
|
SURGICLIP PREM S 9.0 TITANIUM
|
Facility
OP
|
$111.36
|
|
| Hospital Charge Code |
40205968
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$89.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.68
|
| Rate for Payer: Aetna Government |
$55.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.72
|
| Rate for Payer: Group Health Inc Commercial |
$55.68
|
| Rate for Payer: Group Health Inc Medicare |
$38.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.68
|
|
|
SURGICLIP PREM S-9.0 TITANIUM
|
Facility
OP
|
$438.48
|
|
| Hospital Charge Code |
64904617
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.47 |
| Max. Negotiated Rate |
$350.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$241.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$219.24
|
| Rate for Payer: Aetna Government |
$219.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$350.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$298.17
|
| Rate for Payer: Group Health Inc Commercial |
$219.24
|
| Rate for Payer: Group Health Inc Medicare |
$153.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$219.24
|
|
|
SURGIMED 2.0 COLLAGEN MATRIX
|
Facility
OP
|
$11,050.00
|
|
|
Service Code
|
HCPCS C9360
|
| Hospital Charge Code |
40205000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$7,182.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,077.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.32
|
| Rate for Payer: Aetna Government |
$13.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,525.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,353.75
|
| Rate for Payer: Group Health Inc Commercial |
$5,525.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,867.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,525.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,182.50
|
|
|
SURGIMED 2.0 COLLAGEN MATRIX
|
Facility
IP
|
$11,050.00
|
|
|
Service Code
|
HCPCS C9360
|
| Hospital Charge Code |
40205000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,525.00 |
| Max. Negotiated Rate |
$5,525.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,525.00
|
|
|
SURGIMEND COLLAGEN MTX SFT TISS
|
Facility
OP
|
$48.00
|
|
| Hospital Charge Code |
40209552
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.00
|
| Rate for Payer: Aetna Government |
$24.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.64
|
| Rate for Payer: Group Health Inc Commercial |
$24.00
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.00
|
|
|
SURGINEEDLE SGL USE
|
Facility
OP
|
$29.65
|
|
| Hospital Charge Code |
64907090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$23.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.82
|
| Rate for Payer: Aetna Government |
$14.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.16
|
| Rate for Payer: Group Health Inc Commercial |
$14.82
|
| Rate for Payer: Group Health Inc Medicare |
$10.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.82
|
|
|
SURGISIS IHM INGUINAL HERNIA
|
Facility
OP
|
$370.00
|
|
| Hospital Charge Code |
40202011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$203.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$185.00
|
| Rate for Payer: Aetna Government |
$185.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$296.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$251.60
|
| Rate for Payer: Group Health Inc Commercial |
$185.00
|
| Rate for Payer: Group Health Inc Medicare |
$129.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.00
|
|
|
SURG PATH LEVEL I GROSS EXAM
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 88300
|
| Hospital Charge Code |
40635401
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Brighton Health Commercial |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.64
|
| Rate for Payer: Group Health Inc Commercial |
$34.43
|
| Rate for Payer: Group Health Inc Medicare |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$34.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$30.99
|
|
|
SURG PATH LEVEL IV GROSS & MICRO
|
Facility
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
40635418
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.66
|
| Rate for Payer: Aetna Government |
$62.66
|
| Rate for Payer: Brighton Health Commercial |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.77
|
| Rate for Payer: Group Health Inc Commercial |
$62.66
|
| Rate for Payer: Group Health Inc Medicare |
$62.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare |
$56.39
|
|
