|
US VV RETROPERITONEAL LIM
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Hospital Charge Code |
41307802
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.45 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.45
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.39
|
|
|
US VV SAPHENOUS MAP BIL
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
41307803
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$173.96 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.96
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.29
|
|
|
US VV SAPHENOUS MAP UNI
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Hospital Charge Code |
41307804
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$109.71 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.71
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.90
|
|
|
US XTR NON-VASC COMPLETE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76881 TC
|
| Hospital Charge Code |
41304038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.53
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.92
|
|
|
UTER DILATORS S/ST45-47 TO 77-79
|
Facility
OP
|
$1,044.00
|
|
| Hospital Charge Code |
40200684
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$835.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$574.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$522.00
|
| Rate for Payer: Aetna Government |
$522.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$835.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$709.92
|
| Rate for Payer: Group Health Inc Commercial |
$522.00
|
| Rate for Payer: Group Health Inc Medicare |
$365.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$522.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$522.00
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
IP
|
$32,678.89
|
|
|
Service Code
|
MS-DRG 742
|
| Min. Negotiated Rate |
$14,897.73 |
| Max. Negotiated Rate |
$32,678.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,274.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,038.13
|
| Rate for Payer: Aetna Government |
$32,038.13
|
| Rate for Payer: Brighton Health Commercial |
$25,837.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,678.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30,771.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,394.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,436.22
|
| Rate for Payer: EmblemHealth Commercial |
$15,279.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,038.13
|
| Rate for Payer: Group Health Inc Commercial |
$32,038.13
|
| Rate for Payer: Group Health Inc Medicare |
$32,038.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,038.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,897.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,038.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,038.13
|
| Rate for Payer: Wellcare Medicare |
$30,436.22
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$23,910.58
|
|
|
Service Code
|
MS-DRG 743
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$23,910.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,133.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,441.75
|
| Rate for Payer: Aetna Government |
$23,441.75
|
| Rate for Payer: Brighton Health Commercial |
$16,849.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,910.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,066.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,559.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,269.66
|
| Rate for Payer: EmblemHealth Commercial |
$9,964.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,441.75
|
| Rate for Payer: Group Health Inc Commercial |
$1,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$23,441.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,441.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,900.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,441.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,441.75
|
| Rate for Payer: Wellcare Medicare |
$22,269.66
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
IP
|
$32,751.03
|
|
|
Service Code
|
MS-DRG 740
|
| Min. Negotiated Rate |
$14,930.62 |
| Max. Negotiated Rate |
$32,751.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,349.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,108.85
|
| Rate for Payer: Aetna Government |
$32,108.85
|
| Rate for Payer: Brighton Health Commercial |
$25,911.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,751.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30,859.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,466.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,503.41
|
| Rate for Payer: EmblemHealth Commercial |
$15,323.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,108.85
|
| Rate for Payer: Group Health Inc Commercial |
$32,108.85
|
| Rate for Payer: Group Health Inc Medicare |
$32,108.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,108.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,930.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,108.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,108.85
|
| Rate for Payer: Wellcare Medicare |
$30,503.41
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
IP
|
$62,449.88
|
|
|
Service Code
|
MS-DRG 739
|
| Min. Negotiated Rate |
$26,726.55 |
| Max. Negotiated Rate |
$62,449.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53,322.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57,476.46
|
| Rate for Payer: Aetna Government |
$57,476.46
|
| Rate for Payer: Brighton Health Commercial |
$52,436.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58,625.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62,449.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51,536.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$54,602.64
|
| Rate for Payer: EmblemHealth Commercial |
$31,009.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$57,476.46
|
| Rate for Payer: Group Health Inc Commercial |
$57,476.46
|
| Rate for Payer: Group Health Inc Medicare |
$57,476.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57,476.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,726.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57,476.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57,476.46
|
| Rate for Payer: Wellcare Medicare |
$54,602.64
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$25,852.63
|
|
|
Service Code
|
MS-DRG 741
|
| Min. Negotiated Rate |
$11,141.50 |
| Max. Negotiated Rate |
$25,852.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,158.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,345.72
|
| Rate for Payer: Aetna Government |
$25,345.72
|
| Rate for Payer: Brighton Health Commercial |
$18,839.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,852.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,437.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,516.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,078.43
|
| Rate for Payer: EmblemHealth Commercial |
$11,141.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,345.72
|
| Rate for Payer: Group Health Inc Commercial |
$25,345.72
|
| Rate for Payer: Group Health Inc Medicare |
$25,345.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,345.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,785.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,345.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,345.72
|
| Rate for Payer: Wellcare Medicare |
$24,078.43
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
IP
|
$35,393.29
|
|
|
Service Code
|
MS-DRG 737
|
| Min. Negotiated Rate |
$16,135.17 |
| Max. Negotiated Rate |
$35,393.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,103.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,699.30
|
| Rate for Payer: Aetna Government |
$34,699.30
|
| Rate for Payer: Brighton Health Commercial |
$28,620.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,393.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,085.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,128.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,964.34
|
| Rate for Payer: EmblemHealth Commercial |
$16,925.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,699.30
|
| Rate for Payer: Group Health Inc Commercial |
$34,699.30
|
| Rate for Payer: Group Health Inc Medicare |
$34,699.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,699.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,135.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,699.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,699.30
|
| Rate for Payer: Wellcare Medicare |
$32,964.34
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
IP
|
$67,128.06
|
|
|
Service Code
|
MS-DRG 736
|
| Min. Negotiated Rate |
$28,473.41 |
| Max. Negotiated Rate |
$67,128.06 |
| Rate for Payer: Group Health Inc Medicare |
$61,233.13
|
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57,316.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61,233.13
|
| Rate for Payer: Aetna Government |
$61,233.13
|
| Rate for Payer: Brighton Health Commercial |
$56,364.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62,457.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67,128.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55,396.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$58,171.47
|
| Rate for Payer: EmblemHealth Commercial |
$33,332.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$61,233.13
|
| Rate for Payer: Group Health Inc Commercial |
$61,233.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61,233.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28,473.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61,233.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61,233.13
|
| Rate for Payer: Wellcare Medicare |
$58,171.47
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$26,776.30
|
|
|
Service Code
|
MS-DRG 738
|
| Min. Negotiated Rate |
$11,701.40 |
| Max. Negotiated Rate |
$26,776.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,121.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,251.27
|
| Rate for Payer: Aetna Government |
$26,251.27
|
| Rate for Payer: Brighton Health Commercial |
$19,786.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,776.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23,565.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,447.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,938.71
|
| Rate for Payer: EmblemHealth Commercial |
$11,701.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,251.27
|
| Rate for Payer: Group Health Inc Commercial |
$26,251.27
|
| Rate for Payer: Group Health Inc Medicare |
$26,251.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,251.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,206.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,251.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,251.27
|
| Rate for Payer: Wellcare Medicare |
$24,938.71
|
|
|
UVULECTOMY
|
Facility
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 42140
|
| Hospital Charge Code |
30305004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.65 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,723.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
VAC CANISTER 500ML
|
Facility
OP
|
$706.24
|
|
| Hospital Charge Code |
40209319
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$247.18 |
| Max. Negotiated Rate |
$564.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$353.12
|
| Rate for Payer: Aetna Government |
$353.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$480.24
|
| Rate for Payer: Group Health Inc Commercial |
$353.12
|
| Rate for Payer: Group Health Inc Medicare |
$247.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.12
|
|
|
VACURETTE 14MM CURVED #21593A
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
64906518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
|
|
VACURETTE CURVE 7MM
|
Facility
OP
|
$11.44
|
|
| Hospital Charge Code |
64904009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$9.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.72
|
| Rate for Payer: Aetna Government |
$5.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.78
|
| Rate for Payer: Group Health Inc Commercial |
$5.72
|
| Rate for Payer: Group Health Inc Medicare |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.72
|
|
|
VACURETTE SIZE 10
|
Facility
OP
|
$16.20
|
|
| Hospital Charge Code |
64902913
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.10
|
| Rate for Payer: Aetna Government |
$8.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.02
|
| Rate for Payer: Group Health Inc Commercial |
$8.10
|
| Rate for Payer: Group Health Inc Medicare |
$5.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.10
|
|
|
VACURETTE SIZE 12
|
Facility
OP
|
$13.50
|
|
| Hospital Charge Code |
64902915
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.75
|
| Rate for Payer: Aetna Government |
$6.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.18
|
| Rate for Payer: Group Health Inc Commercial |
$6.75
|
| Rate for Payer: Group Health Inc Medicare |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.75
|
|
|
VACURETTE SIZE 7
|
Facility
OP
|
$11.75
|
|
| Hospital Charge Code |
64902906
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.88
|
| Rate for Payer: Aetna Government |
$5.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.99
|
| Rate for Payer: Group Health Inc Commercial |
$5.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.88
|
|
|
VACURETTE SIZE 8
|
Facility
OP
|
$11.45
|
|
| Hospital Charge Code |
64902909
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.72
|
| Rate for Payer: Aetna Government |
$5.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.79
|
| Rate for Payer: Group Health Inc Commercial |
$5.72
|
| Rate for Payer: Group Health Inc Medicare |
$4.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.72
|
|
|
VACURETTE SIZE 9
|
Facility
OP
|
$16.20
|
|
| Hospital Charge Code |
64902911
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.10
|
| Rate for Payer: Aetna Government |
$8.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.02
|
| Rate for Payer: Group Health Inc Commercial |
$8.10
|
| Rate for Payer: Group Health Inc Medicare |
$5.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.10
|
|
|
VAC WHITE FOAM LG
|
Facility
OP
|
$32.18
|
|
| Hospital Charge Code |
40201956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$25.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.09
|
| Rate for Payer: Aetna Government |
$16.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.88
|
| Rate for Payer: Group Health Inc Commercial |
$16.09
|
| Rate for Payer: Group Health Inc Medicare |
$11.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.09
|
|
|
VAC WHITE FOAM SM
|
Facility
OP
|
$25.19
|
|
| Hospital Charge Code |
40201955
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.60
|
| Rate for Payer: Aetna Government |
$12.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.13
|
| Rate for Payer: Group Health Inc Commercial |
$12.60
|
| Rate for Payer: Group Health Inc Medicare |
$8.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.60
|
|
|
VAG DEL AFTR CESARIN INCL ANTE/PO
|
Facility
OP
|
$8,701.05
|
|
|
Service Code
|
HCPCS 59610
|
| Hospital Charge Code |
40002231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$4,785.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,785.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,523.00
|
| Rate for Payer: Aetna Government |
$2,523.00
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,982.24
|
| Rate for Payer: Group Health Inc Commercial |
$4,350.52
|
| Rate for Payer: Group Health Inc Medicare |
$3,045.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,350.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,350.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,313.60
|
|
