|
SP FNA BX W/US GDN EA ADDL
|
Facility
OP
|
$923.79
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
41546541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.17
|
| Rate for Payer: Aetna Government |
$42.17
|
| 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 |
$53.29
|
| Rate for Payer: Group Health Inc Commercial |
$461.90
|
| Rate for Payer: Group Health Inc Medicare |
$323.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.21
|
|
|
SP F/UP ANGIOGRAPHY EXISTING CATH
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75898 TC
|
| Hospital Charge Code |
41543351
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,729.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,470.14
|
| Rate for Payer: Aetna Government |
$2,470.14
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| 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 |
$2,470.14
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.14
|
|
|
SP GALACTOGRAM MULTIPLE
|
Facility
OP
|
$473.48
|
|
|
Service Code
|
HCPCS 19030 TC
|
| Hospital Charge Code |
41542813
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$260.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$236.74
|
| Rate for Payer: Aetna Government |
$236.74
|
| 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 |
$236.74
|
| Rate for Payer: Group Health Inc Medicare |
$165.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.74
|
|
|
SP GALACTOGRAM SINGLE
|
Facility
OP
|
$258.64
|
|
|
Service Code
|
HCPCS 19030 TC
|
| Hospital Charge Code |
41542812
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.32
|
| Rate for Payer: Aetna Government |
$129.32
|
| 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: Group Health Inc Commercial |
$129.32
|
| Rate for Payer: Group Health Inc Medicare |
$90.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.32
|
|
|
SP GASTRO CATHER CHECK
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 49465 TC
|
| Hospital Charge Code |
41547450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.04 |
| Max. Negotiated Rate |
$2,915.00 |
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| 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
|
|
|
SP HEMO-DIALYSIS EVAL
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93990 TC
|
| Hospital Charge Code |
41201178
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$118.81 |
| 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 |
$137.44
|
| 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 |
$152.71
|
|
|
SPHERICAL RES 100CC (72404156)
|
Facility
IP
|
$5,505.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64904576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,752.50 |
| Max. Negotiated Rate |
$2,752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,752.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,752.50
|
|
|
SPHERICAL RES 100CC (72404156)
|
Facility
OP
|
$5,505.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64904576
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,926.75 |
| Max. Negotiated Rate |
$5,780.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,027.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,752.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,165.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,780.25
|
| Rate for Payer: Group Health Inc Commercial |
$2,752.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,926.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,752.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,752.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,578.25
|
|
|
SPHINCTEROTOME AUTOTOME CANN 20MM
|
Facility
OP
|
$697.50
|
|
| Hospital Charge Code |
64903912
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$244.12 |
| Max. Negotiated Rate |
$558.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$383.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$348.75
|
| Rate for Payer: Aetna Government |
$348.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$558.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$474.30
|
| Rate for Payer: Group Health Inc Commercial |
$348.75
|
| Rate for Payer: Group Health Inc Medicare |
$244.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.75
|
|
|
Sphincterotomy, anal, division of sphincter (separate procedure)
|
Facility
OP
|
$3,246.99
|
|
|
Service Code
|
CPT 46080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.92 |
| Max. Negotiated Rate |
$3,246.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| 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 |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
SPHINETEROTOMY
|
Facility
OP
|
$7,099.93
|
|
|
Service Code
|
HCPCS 46080
|
| Hospital Charge Code |
40011225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.92 |
| Max. Negotiated Rate |
$3,549.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| 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 |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,549.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
SP HIP ARTHOGRAM W/ANESTHESIA
|
Facility
OP
|
$1,027.56
|
|
|
Service Code
|
HCPCS 27095 TC
|
| Hospital Charge Code |
41561911
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$359.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$565.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$513.78
|
| Rate for Payer: Aetna Government |
$513.78
|
| 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 |
$513.78
|
| Rate for Payer: Group Health Inc Medicare |
$359.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$513.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$513.78
|
|
|
SP HIP ARTHROGRAM
|
Facility
OP
|
$864.39
|
|
|
Service Code
|
HCPCS 27093 TC
|
| Hospital Charge Code |
41547466
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$302.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$475.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$432.20
|
| Rate for Payer: Aetna Government |
$432.20
|
| 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 |
$432.20
|
| Rate for Payer: Group Health Inc Medicare |
$302.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.20
|
|
|
SP HYSTEROSALPINGOGRAM
|
Facility
OP
|
$371.20
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
41542821
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$63.69 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Government |
$72.24
|
| 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 |
$63.69
|
| Rate for Payer: Group Health Inc Commercial |
$185.60
|
| Rate for Payer: Group Health Inc Medicare |
$129.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.77
|
|
|
SP ILIAC TRANSLUMBAR
|
Facility
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 0238T
|
| Hospital Charge Code |
41542768
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$24,139.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$20,278.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
SP ILLEOCONDUIT INJECTION
|
Facility
OP
|
$301.35
|
|
|
Service Code
|
HCPCS 50690 TC
|
| Hospital Charge Code |
41547641
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.47 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.68
|
| Rate for Payer: Aetna Government |
$150.68
|
| 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 |
$150.68
|
| Rate for Payer: Group Health Inc Medicare |
$105.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.68
|
|
|
SP IMPLANTABLE CHEST PORT
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36561 TC
|
| Hospital Charge Code |
41561830
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,616.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| 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 |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
|
|
SPINAL ACCESSORY NERVE
|
Facility
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
30305024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
SPINAL CD STIMULATOR MULTI DIG
|
Facility
OP
|
$15,915.69
|
|
| Hospital Charge Code |
40205728
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5,570.49 |
| Max. Negotiated Rate |
$12,732.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,753.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,957.84
|
| Rate for Payer: Aetna Government |
$7,957.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,732.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,822.67
|
| Rate for Payer: Group Health Inc Commercial |
$7,957.84
|
| Rate for Payer: Group Health Inc Medicare |
$5,570.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,957.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,957.84
|
|
|
SPINAL CORD STIM LEAD 50CM 16IN
|
Facility
IP
|
$3,006.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
40204561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.00 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,503.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,503.00
|
|
|
SPINAL CORD STIM LEAD 50CM 16IN
|
Facility
OP
|
$3,006.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
40204561
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.66 |
| Max. Negotiated Rate |
$3,156.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,653.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$550.66
|
| Rate for Payer: Aetna Government |
$550.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,503.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,728.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,156.30
|
| Rate for Payer: Group Health Inc Commercial |
$1,503.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,052.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,503.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,503.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,953.90
|
|
|
SPINAL CORD STIMULATOR
|
Facility
OP
|
$8,482.68
|
|
| Hospital Charge Code |
40205729
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,968.94 |
| Max. Negotiated Rate |
$6,786.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,665.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,241.34
|
| Rate for Payer: Aetna Government |
$4,241.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,786.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,768.22
|
| Rate for Payer: Group Health Inc Commercial |
$4,241.34
|
| Rate for Payer: Group Health Inc Medicare |
$2,968.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,241.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,241.34
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
IP
|
$34,978.83
|
|
|
Service Code
|
MS-DRG 052
|
| Min. Negotiated Rate |
$15,946.23 |
| Max. Negotiated Rate |
$34,978.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28,671.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,292.97
|
| Rate for Payer: Aetna Government |
$34,292.97
|
| Rate for Payer: Brighton Health Commercial |
$28,195.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34,978.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33,579.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27,711.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,578.32
|
| Rate for Payer: EmblemHealth Commercial |
$16,674.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,292.97
|
| Rate for Payer: Group Health Inc Commercial |
$34,292.97
|
| Rate for Payer: Group Health Inc Medicare |
$34,292.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,292.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,946.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,292.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,292.97
|
| Rate for Payer: Wellcare Medicare |
$32,578.32
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
IP
|
$21,389.98
|
|
|
Service Code
|
MS-DRG 053
|
| Min. Negotiated Rate |
$8,436.09 |
| Max. Negotiated Rate |
$21,389.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,506.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,970.57
|
| Rate for Payer: Aetna Government |
$20,970.57
|
| Rate for Payer: Brighton Health Commercial |
$14,265.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,389.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,989.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,020.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,922.04
|
| Rate for Payer: EmblemHealth Commercial |
$8,436.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,970.57
|
| Rate for Payer: Group Health Inc Commercial |
$20,970.57
|
| Rate for Payer: Group Health Inc Medicare |
$20,970.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,970.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,751.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,970.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,970.57
|
| Rate for Payer: Wellcare Medicare |
$19,922.04
|
|
|
SPINAL FLUID* PROTEIN TOTAL
|
Facility
OP
|
$9.18
|
|
|
Service Code
|
HCPCS 84155
|
| Hospital Charge Code |
40602195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.67
|
| Rate for Payer: Aetna Government |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.67
|
| Rate for Payer: EmblemHealth Commercial |
$3.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.27
|
| Rate for Payer: Group Health Inc Commercial |
$3.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.67
|
| Rate for Payer: Healthfirst QHP |
$3.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.94
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
|
