|
SP REPOSITION GI FEED TBE
|
Facility
|
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 43761 TC
|
| Hospital Charge Code |
41542710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$200.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$200.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$200.07
|
| Rate for Payer: Brighton Health Commercial |
$533.59
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| 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 |
$285.81
|
| Rate for Payer: EmblemHealth Commercial |
$285.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| Rate for Payer: Group Health Inc Commercial |
$285.81
|
| Rate for Payer: Group Health Inc Medicare |
$285.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.94
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: Humana Medicare |
$291.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
|
SP RETROGRADE BRACHIAL ARTERY
|
Facility
|
OP
|
$1,475.15
|
|
|
Service Code
|
HCPCS 36140 TC
|
| Hospital Charge Code |
41542008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$475.11
|
| Rate for Payer: Aetna Government |
$475.11
|
| Rate for Payer: Brighton Health Commercial |
$1,106.36
|
| 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 |
$737.58
|
| Rate for Payer: Group Health Inc Medicare |
$516.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$737.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$737.58
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP REV IMPL INTRAVENOUS INF PUMP
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36575 TC
|
| Hospital Charge Code |
41547713
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.47
|
| Rate for Payer: Aetna Government |
$726.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.53
|
| Rate for Payer: Brighton Health Commercial |
$1,432.24
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.47
|
| 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 |
$726.47
|
| Rate for Payer: EmblemHealth Commercial |
$726.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.56
|
| Rate for Payer: Group Health Inc Commercial |
$726.47
|
| Rate for Payer: Group Health Inc Medicare |
$726.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.50
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: Humana Medicare |
$741.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.18
|
| Rate for Payer: Wellcare Medicare |
$690.15
|
|
|
SP REV IMPL INTRAVENOUS INF PUMP
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36575 TC
|
| Hospital Charge Code |
41547713
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$726.47
|
|
|
SP REV IMPL VEN ACC PT W/WO SUB
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36575 TC
|
| Hospital Charge Code |
41547603
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.47
|
| Rate for Payer: Aetna Government |
$726.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.53
|
| Rate for Payer: Brighton Health Commercial |
$1,432.24
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.47
|
| 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 |
$726.47
|
| Rate for Payer: EmblemHealth Commercial |
$726.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.56
|
| Rate for Payer: Group Health Inc Commercial |
$726.47
|
| Rate for Payer: Group Health Inc Medicare |
$726.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.50
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: Humana Medicare |
$741.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.18
|
| Rate for Payer: Wellcare Medicare |
$690.15
|
|
|
SP REV IMPL VEN ACC PT W/WO SUB
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36575 TC
|
| Hospital Charge Code |
41547603
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$726.47
|
|
|
SP RFA BONE
|
Facility
|
IP
|
$17,690.84
|
|
|
Service Code
|
HCPCS 20982 TC
|
| Hospital Charge Code |
41548037
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$15,219.83
|
|
|
SP RFA BONE
|
Facility
|
OP
|
$17,690.84
|
|
|
Service Code
|
HCPCS 20982 TC
|
| Hospital Charge Code |
41548037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$15,524.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,219.83
|
| Rate for Payer: Aetna Government |
$15,219.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10,653.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10,653.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10,653.88
|
| Rate for Payer: Brighton Health Commercial |
$13,268.13
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15,219.83
|
| 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 |
$15,219.83
|
| Rate for Payer: EmblemHealth Commercial |
$15,219.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12,936.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13,545.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,219.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13,545.65
|
| Rate for Payer: Group Health Inc Commercial |
$15,219.83
|
| Rate for Payer: Group Health Inc Medicare |
$15,219.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,845.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,219.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,936.86
|
| Rate for Payer: Healthfirst QHP |
$15,219.83
|
| Rate for Payer: Humana Medicare |
$15,524.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,219.83
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,219.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,219.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,175.86
|
| Rate for Payer: Wellcare Medicare |
$14,458.84
|
|
|
SP RFA KIDNEY
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 50592 TC
|
| Hospital Charge Code |
41548036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$10,980.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,670.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,670.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,670.77
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$6,672.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Humana Medicare |
$6,805.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
SP RFA KIDNEY
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 50592 TC
|
| Hospital Charge Code |
41548036
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
|
SP RFA LUNG
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 32998 TC
|
| Hospital Charge Code |
41549955
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
|
SP RFA LUNG
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 32998 TC
|
| Hospital Charge Code |
41549955
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$10,980.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,670.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,670.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,670.77
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$6,672.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Humana Medicare |
$6,805.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
SPRING QUATTRO SECURE S LEAD
|
Facility
|
OP
|
$10,678.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
66574666
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$988.18 |
| Max. Negotiated Rate |
$11,211.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,872.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$988.18
|
| Rate for Payer: Aetna Government |
$988.18
|
| Rate for Payer: Brighton Health Commercial |
$6,406.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,339.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,139.85
|
| Rate for Payer: EmblemHealth Commercial |
$5,339.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,211.90
|
| Rate for Payer: Group Health Inc Commercial |
$5,339.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,737.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,339.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,339.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,940.70
|
|
|
SPRING WIRE GUIDE
|
Facility
|
IP
|
$26.02
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
64905219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$13.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
|
|
SPRING WIRE GUIDE
|
Facility
|
OP
|
$26.02
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
64905219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$27.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$15.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.96
|
| Rate for Payer: EmblemHealth Commercial |
$13.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.32
|
| Rate for Payer: Group Health Inc Commercial |
$13.01
|
| Rate for Payer: Group Health Inc Medicare |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.91
|
|
|
SPRING WIRE GUIDE .018 X 25CM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
64905217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.25
|
| Rate for Payer: EmblemHealth Commercial |
$15.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.50
|
| Rate for Payer: Group Health Inc Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.50
|
|
|
SPRING WIRE GUIDE .018 X 25CM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
64905217
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
|
|
SPRINT QUATTRO SECURE LEAD
|
Facility
|
IP
|
$6,700.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
66571494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,350.00 |
| Max. Negotiated Rate |
$3,350.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,350.00
|
|
|
SPRINT QUATTRO SECURE LEAD
|
Facility
|
OP
|
$6,700.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
66571494
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.18 |
| Max. Negotiated Rate |
$7,035.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,685.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$988.18
|
| Rate for Payer: Aetna Government |
$988.18
|
| Rate for Payer: Brighton Health Commercial |
$4,020.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,350.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,852.50
|
| Rate for Payer: EmblemHealth Commercial |
$3,350.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,035.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,350.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,345.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,350.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,355.00
|
|
|
SP RT. HEART/PUL. TRUNK ONLY
|
Facility
|
OP
|
$2,450.50
|
|
|
Service Code
|
HCPCS 36013 TC
|
| Hospital Charge Code |
41547444
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$848.19
|
| Rate for Payer: Aetna Government |
$848.19
|
| Rate for Payer: Brighton Health Commercial |
$1,837.88
|
| 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 |
$1,225.25
|
| Rate for Payer: Group Health Inc Medicare |
$857.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,225.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,225.25
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP SACROILIAC JOINT ARTHOGRAM
|
Facility
|
OP
|
$1,027.56
|
|
|
Service Code
|
HCPCS 27096 TC
|
| Hospital Charge Code |
41561912
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.42 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$161.42
|
| Rate for Payer: Aetna Government |
$161.42
|
| Rate for Payer: Brighton Health Commercial |
$770.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$513.78
|
| Rate for Payer: Group Health Inc Medicare |
$359.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$513.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$513.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP SELECTIVE VAS CATHE- CORO ARTE
|
Facility
|
IP
|
$8,631.78
|
|
|
Service Code
|
HCPCS 93454 TC
|
| Hospital Charge Code |
41547707
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$3,768.27
|
|
|
SP SELECTIVE VAS CATHE- CORO ARTE
|
Facility
|
OP
|
$8,631.78
|
|
|
Service Code
|
HCPCS 93454 TC
|
| Hospital Charge Code |
41547707
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$6,905.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,768.27
|
| Rate for Payer: Aetna Government |
$3,768.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,637.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,637.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,637.79
|
| Rate for Payer: Brighton Health Commercial |
$6,473.84
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Cash Price |
$3,768.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,768.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,905.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,869.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,768.27
|
| Rate for Payer: EmblemHealth Commercial |
$3,768.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,203.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,353.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,768.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,353.76
|
| Rate for Payer: Group Health Inc Commercial |
$3,768.27
|
| Rate for Payer: Group Health Inc Medicare |
$3,768.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,768.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,203.03
|
| Rate for Payer: Healthfirst QHP |
$3,768.27
|
| Rate for Payer: Humana Medicare |
$3,843.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,768.27
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,768.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,768.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,014.62
|
| Rate for Payer: Wellcare Medicare |
$3,579.86
|
|
|
SP SHOULDER ARTHOGRAM
|
Facility
|
OP
|
$439.65
|
|
|
Service Code
|
HCPCS 23350 TC
|
| Hospital Charge Code |
41547468
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.90
|
| Rate for Payer: Aetna Government |
$130.90
|
| Rate for Payer: Brighton Health Commercial |
$329.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$219.82
|
| Rate for Payer: Group Health Inc Medicare |
$153.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$219.82
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP SIALOGRAM
|
Facility
|
OP
|
$419.13
|
|
|
Service Code
|
HCPCS 42550 TC
|
| Hospital Charge Code |
41542818
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.91
|
| Rate for Payer: Aetna Government |
$153.91
|
| Rate for Payer: Brighton Health Commercial |
$314.35
|
| 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 |
$209.56
|
| Rate for Payer: Group Health Inc Medicare |
$146.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.56
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
