|
SP VERTEB LUMBOSACRAL INJ
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 22511 TC
|
| Hospital Charge Code |
41543551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,560.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,560.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,145.52
|
| Rate for Payer: Aetna Government |
$4,145.52
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$4,145.52
|
| Rate for Payer: Group Health Inc Medicare |
$2,901.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,145.52
|
|
|
SP VERTEBROPLASTY ADDL INJ
|
Facility
OP
|
$1,957.50
|
|
|
Service Code
|
HCPCS 22512 TC
|
| Hospital Charge Code |
41543552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$685.12 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,076.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$978.75
|
| Rate for Payer: Aetna Government |
$978.75
|
| 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 |
$978.75
|
| Rate for Payer: Group Health Inc Medicare |
$685.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$978.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$978.75
|
|
|
SP VISC TRANSLUMBAR
|
Facility
OP
|
$5,248.77
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
41542764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,837.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,162.54
|
| Rate for Payer: Aetna Government |
$2,162.54
|
| 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: Group Health Inc Commercial |
$2,624.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,837.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.38
|
|
|
SP WHITAKER TEST
|
Facility
OP
|
$1,685.60
|
|
|
Service Code
|
HCPCS 50396 TC
|
| Hospital Charge Code |
41547455
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$589.96 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$927.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$842.80
|
| Rate for Payer: Aetna Government |
$842.80
|
| Rate for Payer: Cash Price |
$789.96
|
| Rate for Payer: Cash Price |
$789.96
|
| 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 |
$842.80
|
| Rate for Payer: Group Health Inc Medicare |
$589.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$842.80
|
|
|
SP WRIST ARTHOGRAM
|
Facility
OP
|
$525.71
|
|
|
Service Code
|
HCPCS 25246 TC
|
| Hospital Charge Code |
41561910
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$289.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$262.86
|
| Rate for Payer: Aetna Government |
$262.86
|
| 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 |
$262.86
|
| Rate for Payer: Group Health Inc Medicare |
$184.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.86
|
|
|
SQ/IM INJECTION
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96372
|
| Hospital Charge Code |
40509905
|
|
Hospital Revenue Code
|
269
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Healthfirst Essential Plan |
$13.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$13.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$13.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
SQ LIVE YELLOW FEVER VACCINE
|
Facility
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 90717
|
| Hospital Charge Code |
30101238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.52 |
| Max. Negotiated Rate |
$233.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$143.47
|
| Rate for Payer: Aetna Government |
$143.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$179.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$206.21
|
| Rate for Payer: Group Health Inc Commercial |
$179.32
|
| Rate for Payer: Group Health Inc Medicare |
$125.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$233.11
|
|
|
SQ LIVE YELLOW FEVER VACCINE
|
Facility
IP
|
$358.63
|
|
|
Service Code
|
HCPCS 90717
|
| Hospital Charge Code |
30101238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.32 |
| Max. Negotiated Rate |
$179.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
|
|
SREP S/N/A/G/TR/E, 20.1-30.0CM
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 12006
|
| Hospital Charge Code |
30103257
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.89 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$461.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
SREP S/N/A/G/TR/E, OVER 30CM
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 12007
|
| Hospital Charge Code |
30103258
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.85 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$231.52
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SREW 2.0X6MM SQ-FIT
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.50
|
|
|
SREW 2.0X6MM SQ-FIT
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202377
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.55
|
| 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 |
$30.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.05
|
| Rate for Payer: Group Health Inc Commercial |
$30.50
|
| Rate for Payer: Group Health Inc Medicare |
$21.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.65
|
|
|
SREW 2.0X8MM SQ-FIT
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| 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 |
$45.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$94.50
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.50
|
|
|
SREW 2.0X8MM SQ-FIT
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
|
|
SREW 2.3X18 HEX ST COMMAND
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.15
|
| 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 |
$56.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.65
|
| Rate for Payer: Group Health Inc Commercial |
$56.50
|
| Rate for Payer: Group Health Inc Medicare |
$39.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.45
|
|
|
SREW 2.3X18 HEX ST COMMAND
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202382
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$56.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.50
|
|
|
SRS BODY TX MGMT
|
Facility
OP
|
$2,516.85
|
|
|
Service Code
|
HCPCS 77435
|
| Hospital Charge Code |
66542953
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$2,013.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,384.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$788.10
|
| Rate for Payer: Aetna Government |
$788.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,013.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,711.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,258.42
|
| Rate for Payer: Group Health Inc Medicare |
$880.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,258.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,258.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$755.07
|
|
|
SRS LINEAR BASED COMP CRAN,1SESS
|
Facility
OP
|
$24,055.58
|
|
|
Service Code
|
HCPCS 77372
|
| Hospital Charge Code |
66542947
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$19,244.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,230.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,005.37
|
| Rate for Payer: Aetna Government |
$9,005.37
|
| Rate for Payer: Cash Price |
$9,005.37
|
| Rate for Payer: Cash Price |
$9,005.37
|
| Rate for Payer: Cash Price |
$9,005.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,005.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19,244.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,357.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$9,005.37
|
| Rate for Payer: EmblemHealth Commercial |
$9,005.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,005.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$9,005.37
|
| Rate for Payer: Group Health Inc Medicare |
$9,005.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,027.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,005.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8,104.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,005.37
|
| Rate for Payer: Healthfirst QHP |
$9,005.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,005.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,005.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,204.30
|
| Rate for Payer: Wellcare Medicare |
$8,555.10
|
|
|
SRS TX MGMT CEREBRAL LESION
|
Facility
OP
|
$1,664.08
|
|
|
Service Code
|
HCPCS 77432
|
| Hospital Charge Code |
66542952
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$1,331.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$915.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$522.60
|
| Rate for Payer: Aetna Government |
$522.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,331.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,131.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$832.04
|
| Rate for Payer: Group Health Inc Medicare |
$582.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$832.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$832.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$499.54
|
|
|
SS 8.0X9.0MM 25MM
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40207054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.50
|
|
|
SS 8.0X9.0MM 25MM
|
Facility
OP
|
$441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40207054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$463.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$242.55
|
| 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 |
$220.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$253.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$463.05
|
| Rate for Payer: Group Health Inc Commercial |
$220.50
|
| Rate for Payer: Group Health Inc Medicare |
$154.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$286.65
|
|
|
SS ROD 300MM
|
Facility
OP
|
$1,064.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,118.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$585.64
|
| 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 |
$532.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$612.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,118.04
|
| Rate for Payer: Group Health Inc Commercial |
$532.40
|
| Rate for Payer: Group Health Inc Medicare |
$372.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$692.12
|
|
|
SS ROD 300MM
|
Facility
IP
|
$1,064.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209696
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.40 |
| Max. Negotiated Rate |
$532.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.40
|
|
|
SS ROD 480 MM
|
Facility
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.50
|
|
|
SS ROD 480 MM
|
Facility
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209697
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,118.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$585.75
|
| 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 |
$532.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$612.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,118.25
|
| Rate for Payer: Group Health Inc Commercial |
$532.50
|
| Rate for Payer: Group Health Inc Medicare |
$372.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$692.25
|
|
