|
WEDGE PLEXUR 40X15MM X 15DEG
|
Facility
IP
|
$1,712.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.25 |
| Max. Negotiated Rate |
$856.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.25
|
|
|
WEDGE PLEXUR 40X15MM X 15DEG
|
Facility
OP
|
$1,712.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904658
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,798.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$941.88
|
| 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 |
$856.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$984.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,798.12
|
| Rate for Payer: Group Health Inc Commercial |
$856.25
|
| Rate for Payer: Group Health Inc Medicare |
$599.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.12
|
|
|
WEDGE RESEC OVARY UNI OR BILATERA
|
Facility
OP
|
$20,303.53
|
|
|
Service Code
|
HCPCS 58920
|
| Hospital Charge Code |
40059984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$803.30 |
| Max. Negotiated Rate |
$10,151.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,738.54
|
| Rate for Payer: Aetna Government |
$8,738.54
|
| Rate for Payer: Cash Price |
$8,738.54
|
| Rate for Payer: Cash Price |
$8,738.54
|
| Rate for Payer: Cash Price |
$8,738.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,738.54
|
| 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 |
$8,738.54
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$803.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,427.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,777.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,738.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,777.30
|
| Rate for Payer: Group Health Inc Commercial |
$8,738.54
|
| Rate for Payer: Group Health Inc Medicare |
$8,738.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,151.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,738.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$892.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,427.76
|
| Rate for Payer: Healthfirst QHP |
$8,738.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,738.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,738.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,990.83
|
| Rate for Payer: Wellcare Medicare |
$8,301.61
|
|
|
WEEDS
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
WEIGHT MGMT CLASS
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
HCPCS S9449
|
| Hospital Charge Code |
30305708
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.77
|
| Rate for Payer: Aetna Government |
$42.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| 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 |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
|
|
WEST NILE (IGG, IGM) CSF
|
Facility
OP
|
$42.13
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
40728283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.85
|
| Rate for Payer: Aetna Government |
$16.85
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.85
|
| Rate for Payer: EmblemHealth Commercial |
$16.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.00
|
| Rate for Payer: Group Health Inc Commercial |
$16.85
|
| Rate for Payer: Group Health Inc Medicare |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.85
|
| Rate for Payer: Healthfirst QHP |
$16.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.48
|
| Rate for Payer: Wellcare Medicare |
$15.16
|
|
|
WEST NILE VIRUS ANTIBODY
|
Facility
OP
|
$35.98
|
|
|
Service Code
|
HCPCS 86789
|
| Hospital Charge Code |
40729626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$22.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.51
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
WEST NILE VIRUS ANTIBODY, CSF
|
Facility
OP
|
$42.13
|
|
|
Service Code
|
HCPCS 86788
|
| Hospital Charge Code |
40729384
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.85
|
| Rate for Payer: Aetna Government |
$16.85
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Cash Price |
$16.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.85
|
| Rate for Payer: EmblemHealth Commercial |
$16.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.00
|
| Rate for Payer: Group Health Inc Commercial |
$16.85
|
| Rate for Payer: Group Health Inc Medicare |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.85
|
| Rate for Payer: Healthfirst QHP |
$16.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.48
|
| Rate for Payer: Wellcare Medicare |
$15.16
|
|
|
WET DRESSING
|
Facility
OP
|
$13.47
|
|
| Hospital Charge Code |
40206961
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$10.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.74
|
| Rate for Payer: Aetna Government |
$6.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.74
|
| Rate for Payer: Group Health Inc Medicare |
$4.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.74
|
|
|
WET-FIELD ERSR HMSTTC BIPLR INSTR
|
Facility
OP
|
$154.00
|
|
| Hospital Charge Code |
40200848
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$123.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.00
|
| Rate for Payer: Aetna Government |
$77.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$123.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$104.72
|
| Rate for Payer: Group Health Inc Commercial |
$77.00
|
| Rate for Payer: Group Health Inc Medicare |
$53.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
|
|
WHEEL ATTACHMENTS FIXED 3 SINGLE
|
Facility
OP
|
$33.15
|
|
| Hospital Charge Code |
64903191
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$26.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.58
|
| Rate for Payer: Aetna Government |
$16.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.54
|
| Rate for Payer: Group Health Inc Commercial |
$16.58
|
| Rate for Payer: Group Health Inc Medicare |
$11.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.58
|
|
|
WHEELER REPAIR
|
Facility
OP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 67924
|
| Hospital Charge Code |
40072550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$483.17 |
| Max. Negotiated Rate |
$2,930.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,702.32
|
| Rate for Payer: Aetna Government |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,702.32
|
| 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 |
$2,702.32
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$483.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,296.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,405.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,702.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,405.06
|
| Rate for Payer: Group Health Inc Commercial |
$2,702.32
|
| Rate for Payer: Group Health Inc Medicare |
$2,702.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$536.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,296.97
|
| Rate for Payer: Healthfirst QHP |
$2,702.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,702.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,702.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,161.86
|
| Rate for Payer: Wellcare Medicare |
$2,567.20
|
|
|
WHIPPLE PROCEDURE
|
Facility
OP
|
$9,099.13
|
|
|
Service Code
|
HCPCS 48150
|
| Hospital Charge Code |
40011085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$5,004.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,004.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,706.77
|
| Rate for Payer: Aetna Government |
$3,706.77
|
| 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 |
$3,607.27
|
| Rate for Payer: Group Health Inc Commercial |
$4,549.56
|
| Rate for Payer: Group Health Inc Medicare |
$3,184.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,549.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,549.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,008.08
|
|
|
WHITE BLOOD CELLS (WBC), STOOL
|
Facility
OP
|
$18.73
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
40614217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.27
|
| Rate for Payer: EmblemHealth Commercial |
$4.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.27
|
| Rate for Payer: Healthfirst QHP |
$4.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.42
|
| Rate for Payer: Wellcare Medicare |
$3.84
|
|
|
WHITE NUT
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
64905971
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.50
|
| Rate for Payer: Aetna Government |
$5.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$5.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
|
|
WHITE RELOAD FOR ECHELON 45
|
Facility
OP
|
$330.31
|
|
| Hospital Charge Code |
64905171
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$264.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.16
|
| Rate for Payer: Aetna Government |
$165.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.61
|
| Rate for Payer: Group Health Inc Commercial |
$165.16
|
| Rate for Payer: Group Health Inc Medicare |
$115.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.16
|
|
|
WHOLEY 145CM
|
Facility
OP
|
$133.90
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$73.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.60
|
| Rate for Payer: Group Health Inc Commercial |
$66.95
|
| Rate for Payer: Group Health Inc Medicare |
$46.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.04
|
|
|
WHOLEY 145CM
|
Facility
IP
|
$133.90
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66528276
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.95
|
|
|
WIDE EXCISN RECRNT LESN NOSE
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
40062440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$145.82 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
WINDOWING OF CAST
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29730
|
| Hospital Charge Code |
40023260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$182.22
|
| Rate for Payer: Group Health Inc Medicare |
$182.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
WINDOWING OF CAST
|
Facility
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29730
|
| Hospital Charge Code |
30302029
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| 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 |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
WIRE 2.0MM
|
Facility
OP
|
$102.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.21
|
| 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 |
$51.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.31
|
| Rate for Payer: Group Health Inc Commercial |
$51.10
|
| Rate for Payer: Group Health Inc Medicare |
$35.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.43
|
|
|
WIRE 2.0MM
|
Facility
IP
|
$102.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$51.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.10
|
|
|
WIRE 2.0MM
|
Facility
OP
|
$130.00
|
|
| Hospital Charge Code |
64904069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.00
|
| Rate for Payer: Aetna Government |
$65.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
|
|
WIRE BASKET FOR KAIRISON SHAFTS
|
Facility
OP
|
$1,394.00
|
|
| Hospital Charge Code |
40209546
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$487.90 |
| Max. Negotiated Rate |
$1,115.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$766.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$697.00
|
| Rate for Payer: Aetna Government |
$697.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,115.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$947.92
|
| Rate for Payer: Group Health Inc Commercial |
$697.00
|
| Rate for Payer: Group Health Inc Medicare |
$487.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$697.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$697.00
|
|
