|
SUTURE, BARBED 2 PDO 36CMX36CM
|
Facility
OP
|
$925.15
|
|
| Hospital Charge Code |
64906102
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$323.80 |
| Max. Negotiated Rate |
$740.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$508.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$462.58
|
| Rate for Payer: Aetna Government |
$462.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$740.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$629.10
|
| Rate for Payer: Group Health Inc Commercial |
$462.58
|
| Rate for Payer: Group Health Inc Medicare |
$323.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.58
|
|
|
SUTURE BIOSYN
|
Facility
OP
|
$5.70
|
|
| Hospital Charge Code |
64907070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.85
|
| Rate for Payer: Aetna Government |
$2.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.88
|
| Rate for Payer: Group Health Inc Commercial |
$2.85
|
| Rate for Payer: Group Health Inc Medicare |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.85
|
|
|
SUTURE ENDO ASSISTANT
|
Facility
OP
|
$410.79
|
|
| Hospital Charge Code |
64905167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$143.78 |
| Max. Negotiated Rate |
$328.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$225.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$205.40
|
| Rate for Payer: Aetna Government |
$205.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$328.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$279.34
|
| Rate for Payer: Group Health Inc Commercial |
$205.40
|
| Rate for Payer: Group Health Inc Medicare |
$143.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.40
|
|
|
SUTURE ENDOSCOPIC 2-0 48 GRN
|
Facility
OP
|
$930.24
|
|
| Hospital Charge Code |
64906768
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$325.58 |
| Max. Negotiated Rate |
$744.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$511.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$465.12
|
| Rate for Payer: Aetna Government |
$465.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$744.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$632.56
|
| Rate for Payer: Group Health Inc Commercial |
$465.12
|
| Rate for Payer: Group Health Inc Medicare |
$325.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$465.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$465.12
|
|
|
SUTURE ETHILON 8-0 LW TG175-8
|
Facility
OP
|
$10.67
|
|
| Hospital Charge Code |
64906280
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$8.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.34
|
| Rate for Payer: Aetna Government |
$5.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.26
|
| Rate for Payer: Group Health Inc Commercial |
$5.34
|
| Rate for Payer: Group Health Inc Medicare |
$3.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.34
|
|
|
SUTURE FIBER WIRE BLU TAPRD NDL
|
Facility
OP
|
$55.00
|
|
| Hospital Charge Code |
64904570
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.50
|
| Rate for Payer: Aetna Government |
$27.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.40
|
| Rate for Payer: Group Health Inc Commercial |
$27.50
|
| Rate for Payer: Group Health Inc Medicare |
$19.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.50
|
|
|
SUTURE GORETEX CV-5
|
Facility
OP
|
$72.71
|
|
| Hospital Charge Code |
64902585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$58.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.36
|
| Rate for Payer: Aetna Government |
$36.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.44
|
| Rate for Payer: Group Health Inc Commercial |
$36.36
|
| Rate for Payer: Group Health Inc Medicare |
$25.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.36
|
|
|
SUTURE LACE SPLEEN
|
Facility
OP
|
$2,586.65
|
|
|
Service Code
|
HCPCS 38115
|
| Hospital Charge Code |
40019521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$905.33 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,422.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,330.09
|
| Rate for Payer: Aetna Government |
$1,330.09
|
| 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 |
$1,503.44
|
| Rate for Payer: Group Health Inc Commercial |
$1,293.32
|
| Rate for Payer: Group Health Inc Medicare |
$905.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,293.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,293.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,670.49
|
|
|
SUTURE LASS 25 DEG TI RI CU
|
Facility
OP
|
$500.00
|
|
| Hospital Charge Code |
64905794
|
|
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
|
|
|
SUTURE LASS 90 DEG STRAIGHT
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
64905870
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$175.00
|
| Rate for Payer: Aetna Government |
$175.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
|
|
SUTURE MAXON
|
Facility
OP
|
$170.10
|
|
| Hospital Charge Code |
64907074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.54 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.05
|
| Rate for Payer: Aetna Government |
$85.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.67
|
| Rate for Payer: Group Health Inc Commercial |
$85.05
|
| Rate for Payer: Group Health Inc Medicare |
$59.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.05
|
|
|
SUTURE NON-ABSORB 4-0 NURO SH
|
Facility
OP
|
$781.85
|
|
| Hospital Charge Code |
64905891
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$273.65 |
| Max. Negotiated Rate |
$625.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$430.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$390.92
|
| Rate for Payer: Aetna Government |
$390.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$625.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$531.66
|
| Rate for Payer: Group Health Inc Commercial |
$390.92
|
| Rate for Payer: Group Health Inc Medicare |
$273.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$390.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$390.92
|
|
|
SUTURE NON ABSORB 6-0 30 MONO
|
Facility
OP
|
$757.65
|
|
| Hospital Charge Code |
64905906
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$265.18 |
| Max. Negotiated Rate |
$606.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$416.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$378.82
|
| Rate for Payer: Aetna Government |
$378.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$606.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$515.20
|
| Rate for Payer: Group Health Inc Commercial |
$378.82
|
| Rate for Payer: Group Health Inc Medicare |
$265.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$378.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$378.82
|
|
|
SUTURE NON-ABSORBABLE 2 20INL
|
Facility
OP
|
$161.25
|
|
| Hospital Charge Code |
64905070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.44 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.62
|
| Rate for Payer: Aetna Government |
$80.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$129.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$109.65
|
| Rate for Payer: Group Health Inc Commercial |
$80.62
|
| Rate for Payer: Group Health Inc Medicare |
$56.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.62
|
|
|
Suture of digital nerve, hand or foot; 1 nerve
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 64831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$783.63 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$783.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
| Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$870.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
Suture of quadriceps or hamstring muscle rupture; primary
|
Facility
OP
|
$8,273.12
|
|
|
Service Code
|
CPT 27385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$691.55 |
| Max. Negotiated Rate |
$8,273.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$691.55
|
| 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 Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$768.39
|
| 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
|
|
|
SUTURE OF RECENT SMALL WOUNDS UP
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
HCPCS D7910
|
| Hospital Charge Code |
42302040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$120.32
|
| Rate for Payer: Aetna Government |
$120.32
|
| 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 |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
| 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
|
|
|
SUTURE ONE NERVE HAND/FOOT
|
Facility
OP
|
$16,685.43
|
|
|
Service Code
|
HCPCS 64834
|
| Hospital Charge Code |
40009712
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$828.41 |
| Max. Negotiated Rate |
$8,342.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,703.44
|
| Rate for Payer: Aetna Government |
$7,703.44
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Cash Price |
$7,703.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,703.44
|
| 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 |
$7,703.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,547.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,856.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,703.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,856.06
|
| Rate for Payer: Group Health Inc Commercial |
$7,703.44
|
| Rate for Payer: Group Health Inc Medicare |
$7,703.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,342.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,703.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$920.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,547.92
|
| Rate for Payer: Healthfirst QHP |
$7,703.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,703.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,703.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,162.75
|
| Rate for Payer: Wellcare Medicare |
$7,318.27
|
|
|
SUTURE PASSING WIRE
|
Facility
OP
|
$270.00
|
|
| Hospital Charge Code |
64905879
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.00
|
| Rate for Payer: Aetna Government |
$135.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$216.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$183.60
|
| Rate for Payer: Group Health Inc Commercial |
$135.00
|
| Rate for Payer: Group Health Inc Medicare |
$94.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
|
|
SUTURE PEEK ZIP 5.5MM
|
Facility
OP
|
$935.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$981.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$514.25
|
| 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 |
$467.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$537.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$981.75
|
| Rate for Payer: Group Health Inc Commercial |
$467.50
|
| Rate for Payer: Group Health Inc Medicare |
$327.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$607.75
|
|
|
SUTURE PEEK ZIP 5.5MM
|
Facility
IP
|
$935.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903293
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.50 |
| Max. Negotiated Rate |
$467.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.50
|
|
|
SUTURE PERMA0 6-30BKL BRAI-A306H
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
64906580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
|
|
SUTURE POLY-C
|
Facility
OP
|
$15.70
|
|
| Hospital Charge Code |
64907075
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.85
|
| Rate for Payer: Aetna Government |
$7.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.68
|
| Rate for Payer: Group Health Inc Commercial |
$7.85
|
| Rate for Payer: Group Health Inc Medicare |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.85
|
|
|
SUTURE REMOVAL KIT
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41709546
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
SUTURE REMOVAL KIT
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41809546
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
