|
SYNCHROMED II PUMPS
|
Facility
OP
|
$11,200.00
|
|
|
Service Code
|
HCPCS C2626
|
| Hospital Charge Code |
40206085
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.08 |
| Max. Negotiated Rate |
$11,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,160.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$468.08
|
| Rate for Payer: Aetna Government |
$468.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,440.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,760.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,600.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,920.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,600.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,280.00
|
|
|
SYN CMF PLT 2.0MM TIT CUR N 6 H
|
Facility
OP
|
$684.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$376.20
|
| 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 |
$342.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$393.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$718.20
|
| Rate for Payer: Group Health Inc Commercial |
$342.00
|
| Rate for Payer: Group Health Inc Medicare |
$239.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$342.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$444.60
|
|
|
SYN CMF PLT 2.0MM TIT CUR N 6 H
|
Facility
IP
|
$684.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$342.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.00
|
|
|
SYN CMF PLT 2.4MMX8MM CRTX ST SRW
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.00
|
|
|
SYN CMF PLT 2.4MMX8MM CRTX ST SRW
|
Facility
OP
|
$176.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.80
|
| 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 |
$88.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$101.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.80
|
| Rate for Payer: Group Health Inc Commercial |
$88.00
|
| Rate for Payer: Group Health Inc Medicare |
$61.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.40
|
|
|
SYNCOPE AND COLLAPSE
|
Facility
IP
|
$19,688.37
|
|
|
Service Code
|
MS-DRG 312
|
| Min. Negotiated Rate |
$7,404.51 |
| Max. Negotiated Rate |
$19,688.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,732.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,302.32
|
| Rate for Payer: Aetna Government |
$19,302.32
|
| Rate for Payer: Brighton Health Commercial |
$12,520.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,688.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,911.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,305.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,337.20
|
| Rate for Payer: EmblemHealth Commercial |
$7,404.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,302.32
|
| Rate for Payer: Group Health Inc Commercial |
$19,302.32
|
| Rate for Payer: Group Health Inc Medicare |
$19,302.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,302.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,975.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,302.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,302.32
|
| Rate for Payer: Wellcare Medicare |
$18,337.20
|
|
|
SYNERGY STD 10 STEM
|
Facility
OP
|
$9,329.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$9,795.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,131.22
|
| 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 |
$4,664.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,364.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,795.98
|
| Rate for Payer: Group Health Inc Commercial |
$4,664.75
|
| Rate for Payer: Group Health Inc Medicare |
$3,265.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,664.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,664.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,064.18
|
|
|
SYNERGY STD 10 STEM
|
Facility
IP
|
$9,329.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903534
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,664.75 |
| Max. Negotiated Rate |
$4,664.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,664.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,664.75
|
|
|
SYNERGY STEM POROUS
|
Facility
IP
|
$9,329.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,664.75 |
| Max. Negotiated Rate |
$4,664.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,664.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,664.75
|
|
|
SYNERGY STEM POROUS
|
Facility
OP
|
$9,329.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903157
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$9,795.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,131.22
|
| 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 |
$4,664.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,364.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,795.98
|
| Rate for Payer: Group Health Inc Commercial |
$4,664.75
|
| Rate for Payer: Group Health Inc Medicare |
$3,265.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,664.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,664.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,064.18
|
|
|
SYNERGY STEM POROUS SZ12 150MM
|
Facility
IP
|
$9,329.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,664.75 |
| Max. Negotiated Rate |
$4,664.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,664.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,664.75
|
|
|
SYNERGY STEM POROUS SZ12 150MM
|
Facility
OP
|
$9,329.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902655
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$9,795.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,131.22
|
| 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 |
$4,664.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,364.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,795.98
|
| Rate for Payer: Group Health Inc Commercial |
$4,664.75
|
| Rate for Payer: Group Health Inc Medicare |
$3,265.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,664.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,664.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,064.18
|
|
|
SYNHTES CORTICAL SCREW 4.0 X
|
Facility
OP
|
$41.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.82
|
| 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 |
$20.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.58
|
| Rate for Payer: Group Health Inc Commercial |
$20.75
|
| Rate for Payer: Group Health Inc Medicare |
$14.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.98
|
|
|
SYNHTES CORTICAL SCREW 4.0 X
|
Facility
IP
|
$41.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.75
|
|
|
SYNOVECTOMY
|
Facility
OP
|
$2,030.00
|
|
|
Service Code
|
HCPCS D7854
|
| Hospital Charge Code |
42301970
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$710.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,116.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,840.00
|
| Rate for Payer: Aetna Government |
$1,840.00
|
| 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 |
$1,015.00
|
| Rate for Payer: Group Health Inc Medicare |
$710.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,015.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,015.00
|
|
|
SYNOVECTOMY ELBOW
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
40023201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$701.07 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$701.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$778.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SYNOVECTOMY HIP
|
Facility
OP
|
$6,846.53
|
|
|
Service Code
|
HCPCS 27054
|
| Hospital Charge Code |
40023200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.10 |
| Max. Negotiated Rate |
$3,765.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,765.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$704.10
|
| Rate for Payer: Aetna Government |
$704.10
|
| 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 |
$787.52
|
| Rate for Payer: Group Health Inc Commercial |
$3,423.26
|
| Rate for Payer: Group Health Inc Medicare |
$2,396.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,423.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,423.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$875.02
|
|
|
SYNOVECTOMY KNEE
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 27334
|
| Hospital Charge Code |
40029530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$785.06 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$785.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$872.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SYNOVECTOMY LIMITED
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29875
|
| Hospital Charge Code |
40029993
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$565.49 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$565.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$628.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SYNOVECTOMY MAJOR 2 OR MORE COMP
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
40014227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$741.92 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$741.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$824.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SYNOVECTOMY SHOULDER
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 23106
|
| Hospital Charge Code |
40082855
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$575.58 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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: Elderplan Medicare Advantage |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$575.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$639.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
SYN PLUS HA HO STEM SZ 13
|
Facility
IP
|
$9,752.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,876.25 |
| Max. Negotiated Rate |
$4,876.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,876.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,876.25
|
|
|
SYN PLUS HA HO STEM SZ 13
|
Facility
OP
|
$9,752.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$10,240.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,363.88
|
| 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 |
$4,876.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,607.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,240.12
|
| Rate for Payer: Group Health Inc Commercial |
$4,876.25
|
| Rate for Payer: Group Health Inc Medicare |
$3,413.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,876.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,876.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,339.12
|
|
|
SYN POR HO FEM COM SZ13
|
Facility
IP
|
$9,329.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,664.75 |
| Max. Negotiated Rate |
$4,664.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,664.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,664.75
|
|
|
SYN POR HO FEM COM SZ13
|
Facility
OP
|
$9,329.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905234
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$9,795.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,131.22
|
| 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 |
$4,664.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,364.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,795.98
|
| Rate for Payer: Group Health Inc Commercial |
$4,664.75
|
| Rate for Payer: Group Health Inc Medicare |
$3,265.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,664.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,664.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,064.18
|
|
