|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$28,066.12
|
|
|
Service Code
|
MSDRG 550
|
| Min. Negotiated Rate |
$7,895.86 |
| Max. Negotiated Rate |
$28,066.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,577.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,411.72
|
| Rate for Payer: Aetna Government |
$20,411.72
|
| Rate for Payer: Brighton Health Commercial |
$13,351.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,819.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,293.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,445.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,391.13
|
| Rate for Payer: EmblemHealth Commercial |
$7,895.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,411.72
|
| Rate for Payer: Group Health Inc Commercial |
$20,411.72
|
| Rate for Payer: Group Health Inc Medicare |
$20,411.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,411.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,491.45
|
| Rate for Payer: Humana Medicare |
$28,066.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,411.72
|
| Rate for Payer: United Healthcare Commercial |
$18,763.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,411.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,411.72
|
| Rate for Payer: Wellcare Medicare |
$19,391.13
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$142,880.09
|
|
|
Service Code
|
MSDRG 870
|
| Min. Negotiated Rate |
$48,319.45 |
| Max. Negotiated Rate |
$142,880.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102,697.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103,912.79
|
| Rate for Payer: Aetna Government |
$103,912.79
|
| Rate for Payer: Brighton Health Commercial |
$100,991.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105,991.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120,276.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$99,257.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$98,717.15
|
| Rate for Payer: EmblemHealth Commercial |
$59,724.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$103,912.79
|
| Rate for Payer: Group Health Inc Commercial |
$103,912.79
|
| Rate for Payer: Group Health Inc Medicare |
$103,912.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103,912.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48,319.45
|
| Rate for Payer: Humana Medicare |
$142,880.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103,912.79
|
| Rate for Payer: United Healthcare Commercial |
$138,510.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103,912.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103,912.79
|
| Rate for Payer: Wellcare Medicare |
$98,717.15
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$47,879.32
|
|
|
Service Code
|
MSDRG 871
|
| Min. Negotiated Rate |
$16,191.91 |
| Max. Negotiated Rate |
$47,879.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,233.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,821.32
|
| Rate for Payer: Aetna Government |
$34,821.32
|
| Rate for Payer: Brighton Health Commercial |
$28,747.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,517.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,237.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,254.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,080.25
|
| Rate for Payer: EmblemHealth Commercial |
$17,000.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,821.32
|
| Rate for Payer: Group Health Inc Commercial |
$34,821.32
|
| Rate for Payer: Group Health Inc Medicare |
$34,821.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,821.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,191.91
|
| Rate for Payer: Humana Medicare |
$47,879.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,821.32
|
| Rate for Payer: United Healthcare Commercial |
$39,427.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,821.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,821.32
|
| Rate for Payer: Wellcare Medicare |
$33,080.25
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$29,713.57
|
|
|
Service Code
|
MSDRG 872
|
| Min. Negotiated Rate |
$8,831.39 |
| Max. Negotiated Rate |
$29,713.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,185.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,609.87
|
| Rate for Payer: Aetna Government |
$21,609.87
|
| Rate for Payer: Brighton Health Commercial |
$14,933.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,042.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,785.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,677.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,529.38
|
| Rate for Payer: EmblemHealth Commercial |
$8,831.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,609.87
|
| Rate for Payer: Group Health Inc Commercial |
$21,609.87
|
| Rate for Payer: Group Health Inc Medicare |
$21,609.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,609.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,048.59
|
| Rate for Payer: Humana Medicare |
$29,713.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,609.87
|
| Rate for Payer: United Healthcare Commercial |
$20,481.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,609.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,609.87
|
| Rate for Payer: Wellcare Medicare |
$20,529.38
|
|
|
SEPTOPLASTY
|
Facility
|
IP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 30520
|
| Hospital Charge Code |
40109035
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,723.23
|
|
|
SEPTOPLASTY
|
Facility
|
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 30520
|
| Hospital Charge Code |
40109035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,949.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,606.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,606.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,606.26
|
| Rate for Payer: Brighton Health Commercial |
$5,949.88
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Humana Medicare |
$3,797.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft
|
Facility
|
OP
|
$3,797.69
|
|
|
Service Code
|
CPT 30520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,797.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,606.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,606.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,606.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Humana Medicare |
$3,797.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
SEQUESTRECTOMY FOR OSTEOMYLELITIS
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
HCPCS D7550
|
| Hospital Charge Code |
42301850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$468.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$638.25
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
SEQUESTRECTOMY FOR OSTEOMYLELITIS
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
HCPCS D7550
|
| Hospital Charge Code |
42301850
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
SERIES A STANDAR PATELLA28MMX8MM
|
Facility
|
IP
|
$2,208.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,104.00
|
|
|
SERIES A STANDAR PATELLA28MMX8MM
|
Facility
|
OP
|
$2,208.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209935
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,214.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,324.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,269.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,104.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,318.40
|
| Rate for Payer: Group Health Inc Commercial |
$1,104.00
|
| Rate for Payer: Group Health Inc Medicare |
$772.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,104.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,435.20
|
|
|
SERIES A STANDAR PATELLA31MMX8MM
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,289.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$675.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$736.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$614.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$706.10
|
| Rate for Payer: EmblemHealth Commercial |
$614.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,289.40
|
| Rate for Payer: Group Health Inc Commercial |
$614.00
|
| Rate for Payer: Group Health Inc Medicare |
$429.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.20
|
|
|
SERIES A STANDAR PATELLA31MMX8MM
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.00 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
|
|
SERIES A STD PATELLA 31MMX8MM
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.00 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
|
|
SERIES A STD PATELLA 31MMX8MM
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,289.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$675.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$736.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$614.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$706.10
|
| Rate for Payer: EmblemHealth Commercial |
$614.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,289.40
|
| Rate for Payer: Group Health Inc Commercial |
$614.00
|
| Rate for Payer: Group Health Inc Medicare |
$429.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.20
|
|
|
SEROTININ RELEASE ASSAY
|
Facility
|
OP
|
$60.23
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
40609057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$45.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.09
|
| Rate for Payer: Aetna Government |
$24.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.86
|
| Rate for Payer: Brighton Health Commercial |
$45.17
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.09
|
| Rate for Payer: EmblemHealth Commercial |
$24.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.44
|
| Rate for Payer: Group Health Inc Commercial |
$24.09
|
| Rate for Payer: Group Health Inc Medicare |
$24.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.09
|
| Rate for Payer: Healthfirst QHP |
$24.09
|
| Rate for Payer: Humana Medicare |
$24.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare Commercial |
$22.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.27
|
| Rate for Payer: Wellcare Medicare |
$21.68
|
|
|
SEROTININ RELEASE ASSAY
|
Facility
|
IP
|
$60.23
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
40609057
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$24.09
|
|
|
SEROTONIN SERUM
|
Facility
|
OP
|
$77.45
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
40609741
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$58.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.98
|
| Rate for Payer: Aetna Government |
$30.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$21.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$21.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21.69
|
| Rate for Payer: Brighton Health Commercial |
$58.09
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$41.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$30.98
|
| Rate for Payer: EmblemHealth Commercial |
$30.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.57
|
| Rate for Payer: Group Health Inc Commercial |
$30.98
|
| Rate for Payer: Group Health Inc Medicare |
$30.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.98
|
| Rate for Payer: Healthfirst QHP |
$30.98
|
| Rate for Payer: Humana Medicare |
$31.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.98
|
| Rate for Payer: United Healthcare Commercial |
$39.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.78
|
| Rate for Payer: Wellcare Medicare |
$27.88
|
|
|
SEROTONIN SERUM
|
Facility
|
IP
|
$77.45
|
|
|
Service Code
|
HCPCS 84260
|
| Hospital Charge Code |
40609741
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$30.98
|
|
|
SERRATO POLYAXIAL SCREW 5.0X35MM
|
Facility
|
IP
|
$2,332.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40208510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.40 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.40
|
|
|
SERRATO POLYAXIAL SCREW 5.0X35MM
|
Facility
|
OP
|
$2,332.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40208510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,449.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,283.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,399.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,341.35
|
| Rate for Payer: EmblemHealth Commercial |
$1,166.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,449.43
|
| Rate for Payer: Group Health Inc Commercial |
$1,166.40
|
| Rate for Payer: Group Health Inc Medicare |
$816.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,516.31
|
|
|
SERRATO POLYAXIAL SCREW 5.5X30MM
|
Facility
|
IP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40208511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.50 |
| Max. Negotiated Rate |
$1,166.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.50
|
|
|
SERRATO POLYAXIAL SCREW 5.5X30MM
|
Facility
|
OP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40208511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,449.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,283.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,399.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,341.48
|
| Rate for Payer: EmblemHealth Commercial |
$1,166.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,449.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,166.50
|
| Rate for Payer: Group Health Inc Medicare |
$816.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,516.45
|
|
|
SERRATO POLYAXIAL SCREW 5.5X35MM
|
Facility
|
IP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40208513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.50 |
| Max. Negotiated Rate |
$1,166.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.50
|
|
|
SERRATO POLYAXIAL SCREW 5.5X35MM
|
Facility
|
OP
|
$2,333.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40208513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,449.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,283.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,399.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,341.48
|
| Rate for Payer: EmblemHealth Commercial |
$1,166.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,449.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,166.50
|
| Rate for Payer: Group Health Inc Medicare |
$816.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,166.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,166.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,516.45
|
|
