|
STEM 3 STD, AVENIR MULL
|
Facility
IP
|
$11,670.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,835.00 |
| Max. Negotiated Rate |
$5,835.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,835.00
|
|
|
STEM ACCOLADE II 132DEG NECK
|
Facility
IP
|
$17,115.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,557.88 |
| Max. Negotiated Rate |
$8,557.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,557.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,557.88
|
|
|
STEM ACCOLADE II 132DEG NECK
|
Facility
OP
|
$17,115.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905674
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$17,971.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,413.66
|
| 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 |
$8,557.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,841.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,971.54
|
| Rate for Payer: Group Health Inc Commercial |
$8,557.88
|
| Rate for Payer: Group Health Inc Medicare |
$5,990.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,557.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,557.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11,125.24
|
|
|
STEM, ADV 132 SZ 11 SECR-FT
|
Facility
IP
|
$7,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,625.00 |
| Max. Negotiated Rate |
$3,625.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,625.00
|
|
|
STEM, ADV 132 SZ 11 SECR-FT
|
Facility
OP
|
$7,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$7,612.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,987.50
|
| 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 |
$3,625.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,168.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,612.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,625.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,537.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,625.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,712.50
|
|
|
STEM AVENIR LAT HA 12/14
|
Facility
OP
|
$9,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$9,802.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,134.80
|
| 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 |
$4,668.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,368.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,802.80
|
| Rate for Payer: Group Health Inc Commercial |
$4,668.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,267.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,668.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,668.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,068.40
|
|
|
STEM AVENIR LAT HA 12/14
|
Facility
IP
|
$9,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,668.00 |
| Max. Negotiated Rate |
$4,668.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,668.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,668.00
|
|
|
STEM AVENIR MULLER STAND.7-106010
|
Facility
IP
|
$9,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,668.00 |
| Max. Negotiated Rate |
$4,668.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,668.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,668.00
|
|
|
STEM AVENIR MULLER STAND.7-106010
|
Facility
OP
|
$9,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906457
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$9,802.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,134.80
|
| 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 |
$4,668.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,368.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,802.80
|
| Rate for Payer: Group Health Inc Commercial |
$4,668.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,267.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,668.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,668.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,068.40
|
|
|
STEM AVENIR MULLER STANDARD 1
|
Facility
OP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$14,683.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,691.20
|
| 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 |
$6,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,040.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,683.20
|
| Rate for Payer: Group Health Inc Commercial |
$6,992.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,894.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,089.60
|
|
|
STEM AVENIR MULLER STANDARD 1
|
Facility
IP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,992.00 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
|
|
STEM AVENIR MULLER STANDARD 5
|
Facility
OP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$14,683.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,691.20
|
| 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 |
$6,992.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,040.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$14,683.20
|
| Rate for Payer: Group Health Inc Commercial |
$6,992.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,894.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,089.60
|
|
|
STEM AVENIR MULLER STANDARD 5
|
Facility
IP
|
$13,984.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,992.00 |
| Max. Negotiated Rate |
$6,992.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,992.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,992.00
|
|
|
STEM AVENIR MULLER STND 1
|
Facility
IP
|
$11,670.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,835.00 |
| Max. Negotiated Rate |
$5,835.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,835.00
|
|
|
STEM AVENIR MULLER STND 1
|
Facility
OP
|
$11,670.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905659
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$12,253.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,418.50
|
| 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 |
$5,835.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,710.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,253.50
|
| Rate for Payer: Group Health Inc Commercial |
$5,835.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,084.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,835.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,585.50
|
|
|
STEM AVENIR MULLER STND 5
|
Facility
IP
|
$11,670.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,835.00 |
| Max. Negotiated Rate |
$5,835.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,835.00
|
|
|
STEM AVENIR MULLER STND 5
|
Facility
OP
|
$11,670.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905679
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$12,253.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,418.50
|
| 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 |
$5,835.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,710.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,253.50
|
| Rate for Payer: Group Health Inc Commercial |
$5,835.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,084.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,835.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,585.50
|
|
|
STEM AVENIR STD 6 12/14
|
Facility
OP
|
$5,176.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,434.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,846.80
|
| 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 |
$2,588.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,976.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,434.80
|
| Rate for Payer: Group Health Inc Commercial |
$2,588.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,811.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,588.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,588.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,364.40
|
|
|
STEM AVENIR STD 6 12/14
|
Facility
IP
|
$5,176.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,588.00 |
| Max. Negotiated Rate |
$2,588.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,588.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,588.00
|
|
|
STEM CENTRALIZER
|
Facility
OP
|
$407.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$428.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$224.26
|
| 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 |
$203.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$428.14
|
| Rate for Payer: Group Health Inc Commercial |
$203.88
|
| Rate for Payer: Group Health Inc Medicare |
$142.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$265.04
|
|
|
STEM CENTRALIZER
|
Facility
IP
|
$407.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907317
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.88 |
| Max. Negotiated Rate |
$203.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.88
|
|
|
STEM CMTD TRI
|
Facility
OP
|
$4,321.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,537.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,377.03
|
| 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 |
$2,160.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,485.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,537.97
|
| Rate for Payer: Group Health Inc Commercial |
$2,160.94
|
| Rate for Payer: Group Health Inc Medicare |
$1,512.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,160.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,160.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,809.22
|
|
|
STEM CMTD TRI
|
Facility
IP
|
$4,321.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,160.94 |
| Max. Negotiated Rate |
$2,160.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,160.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,160.94
|
|
|
STEM COLLARLESS FOR 11MM X 135MM
|
Facility
OP
|
$10,667.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$11,200.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,867.12
|
| 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 |
$5,333.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,133.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,200.88
|
| Rate for Payer: Group Health Inc Commercial |
$5,333.75
|
| Rate for Payer: Group Health Inc Medicare |
$3,733.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,333.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,333.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,933.88
|
|
|
STEM COLLARLESS FOR 11MM X 135MM
|
Facility
IP
|
$10,667.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,333.75 |
| Max. Negotiated Rate |
$5,333.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,333.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,333.75
|
|
