|
SPINAL FLUIDS GLUCOSE
|
Facility
OP
|
$9.83
|
|
|
Service Code
|
HCPCS 82945
|
| Hospital Charge Code |
40602200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.93
|
| Rate for Payer: Aetna Government |
$3.93
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Cash Price |
$3.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.93
|
| Rate for Payer: EmblemHealth Commercial |
$3.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.50
|
| Rate for Payer: Group Health Inc Commercial |
$3.93
|
| Rate for Payer: Group Health Inc Medicare |
$3.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.93
|
| Rate for Payer: Healthfirst QHP |
$3.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.14
|
| Rate for Payer: Wellcare Medicare |
$3.54
|
|
|
SPINAL FUSION
|
Facility
OP
|
$2,907.69
|
|
|
Service Code
|
HCPCS 22830
|
| Hospital Charge Code |
40021695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$861.56 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,599.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$861.56
|
| Rate for Payer: Aetna Government |
$861.56
|
| 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 |
$971.06
|
| Rate for Payer: Group Health Inc Commercial |
$1,453.84
|
| Rate for Payer: Group Health Inc Medicare |
$1,017.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,453.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,453.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,078.95
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH MCC
|
Facility
IP
|
$114,533.19
|
|
|
Service Code
|
MS-DRG 459
|
| Min. Negotiated Rate |
$46,174.73 |
| Max. Negotiated Rate |
$114,533.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97,793.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99,300.49
|
| Rate for Payer: Aetna Government |
$99,300.49
|
| Rate for Payer: Brighton Health Commercial |
$96,168.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101,286.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114,533.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$94,517.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$94,335.47
|
| Rate for Payer: EmblemHealth Commercial |
$56,872.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$99,300.49
|
| Rate for Payer: Group Health Inc Commercial |
$99,300.49
|
| Rate for Payer: Group Health Inc Medicare |
$99,300.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99,300.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46,174.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99,300.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99,300.49
|
| Rate for Payer: Wellcare Medicare |
$94,335.47
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
IP
|
$63,168.28
|
|
|
Service Code
|
MS-DRG 460
|
| Min. Negotiated Rate |
$26,994.80 |
| Max. Negotiated Rate |
$63,168.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53,935.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$58,053.34
|
| Rate for Payer: Aetna Government |
$58,053.34
|
| Rate for Payer: Brighton Health Commercial |
$53,039.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59,214.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63,168.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52,129.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$55,150.67
|
| Rate for Payer: EmblemHealth Commercial |
$31,366.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$58,053.34
|
| Rate for Payer: Group Health Inc Commercial |
$58,053.34
|
| Rate for Payer: Group Health Inc Medicare |
$58,053.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58,053.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,994.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58,053.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58,053.34
|
| Rate for Payer: Wellcare Medicare |
$55,150.67
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC
|
Facility
IP
|
$104,914.36
|
|
|
Service Code
|
MS-DRG 457
|
| Min. Negotiated Rate |
$42,583.01 |
| Max. Negotiated Rate |
$104,914.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89,580.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91,576.37
|
| Rate for Payer: Aetna Government |
$91,576.37
|
| Rate for Payer: Brighton Health Commercial |
$88,091.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93,407.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104,914.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86,579.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$86,997.55
|
| Rate for Payer: EmblemHealth Commercial |
$52,095.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$91,576.37
|
| Rate for Payer: Group Health Inc Commercial |
$91,576.37
|
| Rate for Payer: Group Health Inc Medicare |
$91,576.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91,576.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42,583.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91,576.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91,576.37
|
| Rate for Payer: Wellcare Medicare |
$86,997.55
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
IP
|
$145,567.31
|
|
|
Service Code
|
MS-DRG 456
|
| Min. Negotiated Rate |
$57,763.03 |
| Max. Negotiated Rate |
$145,567.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124,291.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$124,221.57
|
| Rate for Payer: Aetna Government |
$124,221.57
|
| Rate for Payer: Brighton Health Commercial |
$122,226.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126,706.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$145,567.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120,128.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$118,010.49
|
| Rate for Payer: EmblemHealth Commercial |
$72,282.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$124,221.57
|
| Rate for Payer: Group Health Inc Commercial |
$124,221.57
|
| Rate for Payer: Group Health Inc Medicare |
$124,221.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124,221.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57,763.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124,221.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124,221.57
|
| Rate for Payer: Wellcare Medicare |
$118,010.49
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
IP
|
$78,245.84
|
|
|
Service Code
|
MS-DRG 458
|
| Min. Negotiated Rate |
$32,624.84 |
| Max. Negotiated Rate |
$78,245.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66,809.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70,160.95
|
| Rate for Payer: Aetna Government |
$70,160.95
|
| Rate for Payer: Brighton Health Commercial |
$65,699.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71,564.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78,245.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64,571.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$66,652.90
|
| Rate for Payer: EmblemHealth Commercial |
$38,853.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$70,160.95
|
| Rate for Payer: Group Health Inc Commercial |
$70,160.95
|
| Rate for Payer: Group Health Inc Medicare |
$70,160.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70,160.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32,624.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70,160.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70,160.95
|
| Rate for Payer: Wellcare Medicare |
$66,652.90
|
|
|
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS
|
Facility
IP
|
$59,201.59
|
|
|
Service Code
|
MS-DRG 029
|
| Min. Negotiated Rate |
$25,513.62 |
| Max. Negotiated Rate |
$59,201.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50,548.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54,868.00
|
| Rate for Payer: Aetna Government |
$54,868.00
|
| Rate for Payer: Brighton Health Commercial |
$49,708.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55,965.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59,201.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48,855.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$52,124.60
|
| Rate for Payer: EmblemHealth Commercial |
$29,396.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$54,868.00
|
| Rate for Payer: Group Health Inc Commercial |
$54,868.00
|
| Rate for Payer: Group Health Inc Medicare |
$54,868.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54,868.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25,513.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54,868.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54,868.00
|
| Rate for Payer: Wellcare Medicare |
$52,124.60
|
|
|
SPINAL PROCEDURES WITH MCC
|
Facility
IP
|
$104,064.72
|
|
|
Service Code
|
MS-DRG 028
|
| Min. Negotiated Rate |
$42,265.75 |
| Max. Negotiated Rate |
$104,064.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88,854.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$90,894.09
|
| Rate for Payer: Aetna Government |
$90,894.09
|
| Rate for Payer: Brighton Health Commercial |
$87,378.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92,711.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104,064.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85,878.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$86,349.39
|
| Rate for Payer: EmblemHealth Commercial |
$51,673.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$90,894.09
|
| Rate for Payer: Group Health Inc Commercial |
$90,894.09
|
| Rate for Payer: Group Health Inc Medicare |
$90,894.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90,894.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42,265.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90,894.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90,894.09
|
| Rate for Payer: Wellcare Medicare |
$86,349.39
|
|
|
SPINAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$40,276.04
|
|
|
Service Code
|
MS-DRG 030
|
| Min. Negotiated Rate |
$18,361.13 |
| Max. Negotiated Rate |
$40,276.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34,193.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39,486.31
|
| Rate for Payer: Aetna Government |
$39,486.31
|
| Rate for Payer: Brighton Health Commercial |
$33,625.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40,276.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40,046.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33,048.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$37,511.99
|
| Rate for Payer: EmblemHealth Commercial |
$19,885.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$39,486.31
|
| Rate for Payer: Group Health Inc Commercial |
$39,486.31
|
| Rate for Payer: Group Health Inc Medicare |
$39,486.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39,486.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,361.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39,486.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39,486.31
|
| Rate for Payer: Wellcare Medicare |
$37,511.99
|
|
|
SPINAL PROSTHES COFLEX 12MM
|
Facility
IP
|
$13,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$6,562.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,562.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,562.50
|
|
|
SPINAL PROSTHES COFLEX 12MM
|
Facility
OP
|
$13,125.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$13,781.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,218.75
|
| 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 |
$6,562.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,546.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,781.25
|
| Rate for Payer: Group Health Inc Commercial |
$6,562.50
|
| Rate for Payer: Group Health Inc Medicare |
$4,593.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,562.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,562.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,531.25
|
|
|
SPINAL PUNCT DRAIN CEBROSPINE FLU
|
Facility
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
30105793
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$799.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
SPINAL PUNCT DRAIN CEBROSPINE FLU
|
Facility
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 62272
|
| Hospital Charge Code |
30305793
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$799.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
Spinal puncture, lumbar, diagnostic;
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.63 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: EmblemHealth Commercial |
$799.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| Rate for Payer: Group Health Inc Commercial |
$799.72
|
| Rate for Payer: Group Health Inc Medicare |
$799.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
SPINAL RODS 3.5-6.OMM
|
Facility
OP
|
$905.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$950.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$497.97
|
| 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 |
$452.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$950.67
|
| Rate for Payer: Group Health Inc Commercial |
$452.70
|
| Rate for Payer: Group Health Inc Medicare |
$316.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$452.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$452.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$588.51
|
|
|
SPINAL RODS 3.5-6.OMM
|
Facility
IP
|
$905.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.70 |
| Max. Negotiated Rate |
$452.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$452.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$452.70
|
|
|
SPINAL RODS 6.0MM
|
Facility
OP
|
$3,297.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,462.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,813.70
|
| 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 |
$1,648.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,896.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,462.51
|
| Rate for Payer: Group Health Inc Commercial |
$1,648.82
|
| Rate for Payer: Group Health Inc Medicare |
$1,154.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,648.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,648.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,143.46
|
|
|
SPINAL RODS 6.0MM
|
Facility
IP
|
$3,297.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205262
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,648.82 |
| Max. Negotiated Rate |
$1,648.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,648.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,648.82
|
|
|
SPINAL SPACER 11X11X5MM
|
Facility
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,250.00 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,250.00
|
|
|
SPINAL SPACER 11X11X5MM
|
Facility
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64904215
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,725.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,475.00
|
| 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 |
$2,250.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,587.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,725.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,575.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,250.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,925.00
|
|
|
SPINAL TRAY W 25 GA NEEDLE
|
Facility
OP
|
$36.38
|
|
| Hospital Charge Code |
64903806
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.19
|
| Rate for Payer: Aetna Government |
$18.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.74
|
| Rate for Payer: Group Health Inc Commercial |
$18.19
|
| Rate for Payer: Group Health Inc Medicare |
$12.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.19
|
|
|
SPINE HEALOS11 BONE GFT STP 16ML
|
Facility
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$5,533.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,898.50
|
| 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 |
$2,635.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,030.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,533.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,635.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,844.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,635.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,635.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,425.50
|
|
|
SPINE HEALOS11 BONE GFT STP 16ML
|
Facility
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,635.00 |
| Max. Negotiated Rate |
$2,635.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,635.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,635.00
|
|
|
SPINE HEALOSLL BON GRFT STRPS16ML
|
Facility
IP
|
$5,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40009114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,520.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,520.00
|
|
