|
SURG PATH LEV II GROSS & MICRO
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 88302
|
| Hospital Charge Code |
40635406
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$27.54 |
| Max. Negotiated Rate |
$52.98 |
| 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 |
$52.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$34.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.27
|
| 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 |
$40.30
|
| 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 LEV III GROSS & MICR
|
Facility
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 88304
|
| Hospital Charge Code |
40635409
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$82.41 |
| 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 |
$58.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.57
|
| 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 |
$51.74
|
| 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
|
|
|
SURG PATH LEV V GROSS & MICRO
|
Facility
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 88307
|
| Hospital Charge Code |
40635421
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$140.29 |
| Max. Negotiated Rate |
$472.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Brighton Health Commercial |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$314.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$349.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
SURG PATH LEV VI GROSS & MICRO
|
Facility
OP
|
$1,902.65
|
|
|
Service Code
|
HCPCS 88309
|
| Hospital Charge Code |
40635426
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$194.84 |
| Max. Negotiated Rate |
$1,046.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,046.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$994.39
|
| Rate for Payer: Aetna Government |
$994.39
|
| Rate for Payer: Brighton Health Commercial |
$994.39
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Cash Price |
$994.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$994.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$230.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$194.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$994.39
|
| Rate for Payer: EmblemHealth Commercial |
$994.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$471.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$885.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$994.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$885.01
|
| Rate for Payer: Group Health Inc Commercial |
$994.39
|
| Rate for Payer: Group Health Inc Medicare |
$994.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$951.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$994.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$523.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$994.39
|
| Rate for Payer: Healthfirst QHP |
$994.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$994.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$994.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$795.51
|
| Rate for Payer: Wellcare Medicare |
$894.95
|
|
|
SURG PREP/H/F/DIGITS/<100SQCM
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 15004
|
| Hospital Charge Code |
42500192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$284.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$726.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$284.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$316.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
SURG PROCEDURE FOR ISOLATION TOOT
|
Facility
OP
|
$138.92
|
|
|
Service Code
|
HCPCS D3910
|
| Hospital Charge Code |
42300810
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.46 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$76.41
|
| 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 |
$69.46
|
| 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. REDUC. OSSEOUS TUBEROSITY
|
Facility
OP
|
$800.00
|
|
|
Service Code
|
HCPCS D7485
|
| Hospital Charge Code |
42303411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,772.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$6,772.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
SURG REDUCTION-FIBROUS TUBEROSITY
|
Facility
OP
|
$850.00
|
|
|
Service Code
|
HCPCS D7972
|
| Hospital Charge Code |
42303454
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.51 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$467.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$205.51
|
| Rate for Payer: Aetna Government |
$205.51
|
| 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 |
$425.00
|
| Rate for Payer: Group Health Inc Medicare |
$297.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$425.00
|
|
|
SURG REM ERUP TOOTH REQ FLAP/BONE
|
Facility
OP
|
$212.50
|
|
|
Service Code
|
HCPCS D7210
|
| Hospital Charge Code |
42301655
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| 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: Elderplan Medicare Advantage |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,763.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
SURG REM OF RESIDUAL TOOTH ROOTS
|
Facility
OP
|
$145.00
|
|
|
Service Code
|
HCPCS D7250
|
| Hospital Charge Code |
42301680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.75
|
| 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 |
$72.50
|
| 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
|
|
|
SUSPENSION OF BREAST
|
Facility
OP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 19316
|
| Hospital Charge Code |
40014221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$895.86 |
| Max. Negotiated Rate |
$7,931.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,541.13
|
| Rate for Payer: Aetna Government |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,541.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$7,541.13
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$895.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,409.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,711.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,541.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,711.61
|
| Rate for Payer: Group Health Inc Commercial |
$7,541.13
|
| Rate for Payer: Group Health Inc Medicare |
$7,541.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,931.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,541.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$995.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,409.96
|
| Rate for Payer: Healthfirst QHP |
$7,541.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,541.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,541.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,032.90
|
| Rate for Payer: Wellcare Medicare |
$7,164.07
|
|
|
SUSPENSION OF TESTIS
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
40124282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$467.61 |
| Max. Negotiated Rate |
$4,708.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,000.83
|
| Rate for Payer: Aetna Government |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,000.83
|
| 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 |
$4,000.83
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,400.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,560.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,000.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,560.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,000.83
|
| Rate for Payer: Group Health Inc Medicare |
$4,000.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,000.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$519.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,400.71
|
| Rate for Payer: Healthfirst QHP |
$4,000.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,000.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,000.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,200.66
|
| Rate for Payer: Wellcare Medicare |
$3,800.79
|
|
|
SUSPENSORY,LARGE,W LEG STRAP
|
Facility
OP
|
$21.38
|
|
| Hospital Charge Code |
64901026
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.69
|
| Rate for Payer: Aetna Government |
$10.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.54
|
| Rate for Payer: Group Health Inc Commercial |
$10.69
|
| Rate for Payer: Group Health Inc Medicare |
$7.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.69
|
|
|
SUSPENSORY SUPPORTS
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40205920
|
|
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
|
|
|
Suspensory X-large
|
Facility
OP
|
$38.99
|
|
| Hospital Charge Code |
40205930
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$31.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.50
|
| Rate for Payer: Aetna Government |
$19.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.51
|
| Rate for Payer: Group Health Inc Commercial |
$19.50
|
| Rate for Payer: Group Health Inc Medicare |
$13.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.50
|
|
|
SUT STRATAFX SPIRAL PDO 2XMO
|
Facility
OP
|
$41.41
|
|
| Hospital Charge Code |
40008265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$33.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.70
|
| Rate for Payer: Aetna Government |
$20.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.16
|
| Rate for Payer: Group Health Inc Commercial |
$20.70
|
| Rate for Payer: Group Health Inc Medicare |
$14.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.70
|
|
|
SUTURABLE DURAL REGEN MATRIX
|
Facility
OP
|
$2,518.08
|
|
| Hospital Charge Code |
40209712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.33 |
| Max. Negotiated Rate |
$2,014.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,384.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Government |
$1,259.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,014.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,712.29
|
| Rate for Payer: Group Health Inc Commercial |
$1,259.04
|
| Rate for Payer: Group Health Inc Medicare |
$881.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,259.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,259.04
|
|
|
SUTURE ABSORB 0 18 DYED
|
Facility
OP
|
$793.53
|
|
| Hospital Charge Code |
64905889
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$277.74 |
| Max. Negotiated Rate |
$634.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$436.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$396.76
|
| Rate for Payer: Aetna Government |
$396.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$634.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$539.60
|
| Rate for Payer: Group Health Inc Commercial |
$396.76
|
| Rate for Payer: Group Health Inc Medicare |
$277.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.76
|
|
|
SUTURE ANCHOR BCO 7X 19.5MM
|
Facility
IP
|
$1,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.75 |
| Max. Negotiated Rate |
$543.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$543.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$543.75
|
|
|
SUTURE ANCHOR BCO 7X 19.5MM
|
Facility
OP
|
$1,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,141.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$598.12
|
| 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 |
$543.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$625.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,141.88
|
| Rate for Payer: Group Health Inc Commercial |
$543.75
|
| Rate for Payer: Group Health Inc Medicare |
$380.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$543.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$543.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$706.88
|
|
|
SUTURE ANCHOR BIOCMP CORKSCW
|
Facility
OP
|
$862.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$905.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$474.38
|
| 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 |
$431.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$495.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$905.62
|
| Rate for Payer: Group Health Inc Commercial |
$431.25
|
| Rate for Payer: Group Health Inc Medicare |
$301.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$431.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$431.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$560.62
|
|
|
SUTURE ANCHOR BIOCMP CORKSCW
|
Facility
IP
|
$862.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.25 |
| Max. Negotiated Rate |
$431.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$431.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$431.25
|
|
|
SUTURE AORTA/GRT VESSELS,W/SHUNT/
|
Facility
OP
|
$3,522.93
|
|
|
Service Code
|
HCPCS 33321
|
| Hospital Charge Code |
40034330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,233.03 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,937.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,381.04
|
| Rate for Payer: Aetna Government |
$1,381.04
|
| 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 |
$1,346.22
|
| Rate for Payer: Group Health Inc Commercial |
$1,761.46
|
| Rate for Payer: Group Health Inc Medicare |
$1,233.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,761.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,761.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,495.80
|
|
|
SUTURE, BARBED 0 PDO 36CMX36CM
|
Facility
OP
|
$886.60
|
|
| Hospital Charge Code |
64906103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$310.31 |
| Max. Negotiated Rate |
$709.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$487.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$443.30
|
| Rate for Payer: Aetna Government |
$443.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$709.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$602.89
|
| Rate for Payer: Group Health Inc Commercial |
$443.30
|
| Rate for Payer: Group Health Inc Medicare |
$310.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$443.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$443.30
|
|
|
SUTURE, BARBED 1 PDO 24CMX24CM
|
Facility
OP
|
$566.65
|
|
| Hospital Charge Code |
64906101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.33 |
| Max. Negotiated Rate |
$453.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$311.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.32
|
| Rate for Payer: Aetna Government |
$283.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$453.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$385.32
|
| Rate for Payer: Group Health Inc Commercial |
$283.32
|
| Rate for Payer: Group Health Inc Medicare |
$198.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.32
|
|
