|
CEPHALEXIN 250 MG CAP
|
Facility
OP
|
$0.04
|
|
| Hospital Charge Code |
41651655
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
CEPHALEXIN 500 MG CAP
|
Facility
OP
|
$0.04
|
|
| Hospital Charge Code |
41651656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
CEPHALEXIN 500 MG CAP
|
Facility
OP
|
$0.04
|
|
| Hospital Charge Code |
41641656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
CEPHALOMETRIC FILM
|
Facility
OP
|
$137.50
|
|
|
Service Code
|
HCPCS D0340
|
| Hospital Charge Code |
42300190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$75.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| 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 |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$105.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$105.08
|
| Rate for Payer: Group Health Inc Medicare |
$105.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.32
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
CERAMIC HEAD 2.5MM 32MM
|
Facility
OP
|
$2,518.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,643.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,384.90
|
| 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 |
$1,259.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,447.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,643.90
|
| Rate for Payer: Group Health Inc Commercial |
$1,259.00
|
| Rate for Payer: Group Health Inc Medicare |
$881.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,259.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,259.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,636.70
|
|
|
CERAMIC HEAD 2.5MM 32MM
|
Facility
IP
|
$2,518.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40200529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.00 |
| Max. Negotiated Rate |
$1,259.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,259.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,259.00
|
|
|
CERA RING STANDARD
|
Facility
OP
|
$35.42
|
|
|
Service Code
|
HCPCS A4385
|
| Hospital Charge Code |
40005170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.10
|
| Rate for Payer: Aetna Government |
$3.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.09
|
| Rate for Payer: Group Health Inc Commercial |
$17.71
|
| Rate for Payer: Group Health Inc Medicare |
$12.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.71
|
|
|
CERCLAGE CERVIX DURING PREGNANCY
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
40059986
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.99 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
CERCLAGE CERVIX-NONOBSTETRICAL
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57700
|
| Hospital Charge Code |
40059987
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$401.82 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$401.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$446.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
Cerclage of cervix, during pregnancy; vaginal
|
Facility
OP
|
$3,615.39
|
|
|
Service Code
|
CPT 59320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.99 |
| Max. Negotiated Rate |
$3,615.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
CERCLAGE SET
|
Facility
OP
|
$2,011.25
|
|
| Hospital Charge Code |
64903474
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$703.94 |
| Max. Negotiated Rate |
$1,609.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,106.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,005.62
|
| Rate for Payer: Aetna Government |
$1,005.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,609.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,367.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,005.62
|
| Rate for Payer: Group Health Inc Medicare |
$703.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,005.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,005.62
|
|
|
CERTAS PLUS INLINE PLUS
|
Facility
OP
|
$12,279.40
|
|
| Hospital Charge Code |
64905921
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,297.79 |
| Max. Negotiated Rate |
$9,823.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,753.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,139.70
|
| Rate for Payer: Aetna Government |
$6,139.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9,823.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,349.99
|
| Rate for Payer: Group Health Inc Commercial |
$6,139.70
|
| Rate for Payer: Group Health Inc Medicare |
$4,297.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,139.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,139.70
|
|
|
CERTIFIED TRANSLATION OR ASL SEVI
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
HCPCS D9990
|
| Hospital Charge Code |
42300761
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$1,446.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.24
|
| Rate for Payer: Aetna Government |
$8.24
|
| Rate for Payer: Amida Care Medicaid |
$14.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,446.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.18
|
| Rate for Payer: Group Health Inc Commercial |
$27.50
|
| Rate for Payer: Group Health Inc Medicare |
$19.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.46
|
| Rate for Payer: Healthfirst Essential Plan |
$32.54
|
| Rate for Payer: Healthfirst QHP |
$14.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.46
|
| Rate for Payer: SOMOS Essential |
$32.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.46
|
|
|
CERULOPLASMN
|
Facility
OP
|
$26.85
|
|
|
Service Code
|
HCPCS 82390
|
| Hospital Charge Code |
40609051
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$17.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.74
|
| Rate for Payer: Aetna Government |
$10.74
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.74
|
| Rate for Payer: EmblemHealth Commercial |
$10.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.56
|
| Rate for Payer: Group Health Inc Commercial |
$10.74
|
| Rate for Payer: Group Health Inc Medicare |
$10.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.74
|
| Rate for Payer: Healthfirst QHP |
$10.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.59
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
|
|
CERVICAL 12X14X7
|
Facility
IP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,000.00 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,000.00
|
|
|
CERVICAL 12X14X7
|
Facility
OP
|
$10,000.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,500.00 |
| Max. Negotiated Rate |
$10,500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,500.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,000.00
|
| Rate for Payer: Aetna Government |
$5,000.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,750.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,500.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,000.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,000.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,500.00
|
|
|
CERVICAL COLLAR
|
Facility
OP
|
$45.36
|
|
| Hospital Charge Code |
40200870
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$36.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.68
|
| Rate for Payer: Aetna Government |
$22.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.84
|
| Rate for Payer: Group Health Inc Commercial |
$22.68
|
| Rate for Payer: Group Health Inc Medicare |
$15.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.68
|
|
|
CERVICAL DILATION
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57800
|
| Hospital Charge Code |
30301249
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
CERVICAL DISCECTOMY
|
Facility
OP
|
$5,188.30
|
|
|
Service Code
|
HCPCS 22220
|
| Hospital Charge Code |
40000130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,853.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,692.73
|
| Rate for Payer: Aetna Government |
$1,692.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,910.57
|
| Rate for Payer: Group Health Inc Commercial |
$2,594.15
|
| Rate for Payer: Group Health Inc Medicare |
$1,815.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,594.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,594.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,122.86
|
|
|
CERVICAL LAMINECTOMY
|
Facility
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 63020
|
| Hospital Charge Code |
40000535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,309.02 |
| Max. Negotiated Rate |
$9,058.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,309.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,454.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
CERVICAL OR VAGINAL CA SCREENING
|
Facility
OP
|
$237.88
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
30306680
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.51 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.08
|
| Rate for Payer: Aetna Government |
$103.08
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.74
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.62
|
| Rate for Payer: Healthfirst QHP |
$103.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.46
|
| Rate for Payer: Wellcare Medicare |
$97.93
|
|
|
CERVICAL OR VAGINAL CA SCREENING
|
Facility
OP
|
$237.88
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
30105510
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.51 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.08
|
| Rate for Payer: Aetna Government |
$103.08
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.74
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.62
|
| Rate for Payer: Healthfirst QHP |
$103.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.46
|
| Rate for Payer: Wellcare Medicare |
$97.93
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
IP
|
$51,036.80
|
|
|
Service Code
|
MS-DRG 472
|
| Min. Negotiated Rate |
$22,464.85 |
| Max. Negotiated Rate |
$51,036.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43,577.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48,311.50
|
| Rate for Payer: Aetna Government |
$48,311.50
|
| Rate for Payer: Brighton Health Commercial |
$42,853.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49,277.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51,036.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42,117.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$45,895.92
|
| Rate for Payer: EmblemHealth Commercial |
$25,342.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$48,311.50
|
| Rate for Payer: Group Health Inc Commercial |
$48,311.50
|
| Rate for Payer: Group Health Inc Medicare |
$48,311.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48,311.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22,464.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48,311.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48,311.50
|
| Rate for Payer: Wellcare Medicare |
$45,895.92
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
IP
|
$84,946.21
|
|
|
Service Code
|
MS-DRG 471
|
| Min. Negotiated Rate |
$35,126.80 |
| Max. Negotiated Rate |
$84,946.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72,530.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75,541.50
|
| Rate for Payer: Aetna Government |
$75,541.50
|
| Rate for Payer: Brighton Health Commercial |
$71,325.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77,052.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84,946.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70,101.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$71,764.42
|
| Rate for Payer: EmblemHealth Commercial |
$42,180.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$75,541.50
|
| Rate for Payer: Group Health Inc Commercial |
$75,541.50
|
| Rate for Payer: Group Health Inc Medicare |
$75,541.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75,541.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35,126.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75,541.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75,541.50
|
| Rate for Payer: Wellcare Medicare |
$71,764.42
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
IP
|
$42,492.10
|
|
|
Service Code
|
MS-DRG 473
|
| Min. Negotiated Rate |
$19,274.21 |
| Max. Negotiated Rate |
$42,492.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36,281.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41,449.92
|
| Rate for Payer: Aetna Government |
$41,449.92
|
| Rate for Payer: Brighton Health Commercial |
$35,678.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42,278.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42,492.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35,066.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$39,377.42
|
| Rate for Payer: EmblemHealth Commercial |
$21,099.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$41,449.92
|
| Rate for Payer: Group Health Inc Commercial |
$41,449.92
|
| Rate for Payer: Group Health Inc Medicare |
$41,449.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41,449.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,274.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41,449.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41,449.92
|
| Rate for Payer: Wellcare Medicare |
$39,377.42
|
|
