ACUMED ACTK FIX SYS 20.0MM/2 B/S
|
Facility
IP
|
$916.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205414
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$458.00 |
Max. Negotiated Rate |
$458.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$458.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$458.00
|
|
ACUMED ACUTRAK 2.5MM MINI D/B
|
Facility
OP
|
$530.00
|
|
Hospital Charge Code |
40205655
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$185.50 |
Max. Negotiated Rate |
$424.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.50
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.00
|
Rate for Payer: Aetna Government |
$265.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$424.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$360.40
|
Rate for Payer: Group Health Inc Commercial |
$265.00
|
Rate for Payer: Group Health Inc Medicare |
$185.50
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$265.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$265.00
|
|
ACUMED ACUTRAK FIX SYS 16.0MM
|
Facility
OP
|
$916.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205440
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$961.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$503.80
|
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 |
$458.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$526.70
|
Rate for Payer: Fidelis Medicare Advantage |
$961.80
|
Rate for Payer: Group Health Inc Commercial |
$458.00
|
Rate for Payer: Group Health Inc Medicare |
$320.60
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$458.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$458.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$595.40
|
|
ACUMED ACUTRAK FIX SYS 16.0MM
|
Facility
IP
|
$916.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205440
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$458.00 |
Max. Negotiated Rate |
$458.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$458.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$458.00
|
|
ACUMED GUIDEWIRE .035
|
Facility
IP
|
$18.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40200362
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$9.00 |
Max. Negotiated Rate |
$9.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
|
ACUMED GUIDEWIRE .035
|
Facility
OP
|
$18.00
|
|
Service Code
|
HCPCS C1769
|
Hospital Charge Code |
40200362
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.08 |
Max. Negotiated Rate |
$18.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
Rate for Payer: Aetna Government |
$4.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.35
|
Rate for Payer: Fidelis Medicare Advantage |
$18.90
|
Rate for Payer: Group Health Inc Commercial |
$9.00
|
Rate for Payer: Group Health Inc Medicare |
$6.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
ACUMED MINI ACUTRAX X B/S 30MM
|
Facility
OP
|
$952.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205656
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$999.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$523.60
|
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 |
$476.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.40
|
Rate for Payer: Fidelis Medicare Advantage |
$999.60
|
Rate for Payer: Group Health Inc Commercial |
$476.00
|
Rate for Payer: Group Health Inc Medicare |
$333.20
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$476.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$476.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$618.80
|
|
ACUMED MINI ACUTRAX X B/S 30MM
|
Facility
IP
|
$952.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205656
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$476.00 |
Max. Negotiated Rate |
$476.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$476.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$476.00
|
|
ACUMED OLECRANON PLATE MEDIUM
|
Facility
OP
|
$1,268.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200363
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,331.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$697.40
|
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 |
$634.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$729.10
|
Rate for Payer: Fidelis Medicare Advantage |
$1,331.40
|
Rate for Payer: Group Health Inc Commercial |
$634.00
|
Rate for Payer: Group Health Inc Medicare |
$443.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$634.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$634.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$824.20
|
|
ACUMED OLECRANON PLATE MEDIUM
|
Facility
IP
|
$1,268.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200363
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$634.00 |
Max. Negotiated Rate |
$634.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$634.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$634.00
|
|
ACUMED POSTERIOR PLATE
|
Facility
IP
|
$1,268.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200364
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$634.00 |
Max. Negotiated Rate |
$634.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$634.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$634.00
|
|
ACUMED POSTERIOR PLATE
|
Facility
OP
|
$1,268.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40200364
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,331.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$697.40
|
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 |
$634.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$729.10
|
Rate for Payer: Fidelis Medicare Advantage |
$1,331.40
|
Rate for Payer: Group Health Inc Commercial |
$634.00
|
Rate for Payer: Group Health Inc Medicare |
$443.80
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$634.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$634.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$824.20
|
|
ACUMED SCREW CORTICAL 3.5
|
Facility
OP
|
$185.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205658
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$64.92 |
Max. Negotiated Rate |
$194.78 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102.02
|
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 |
$92.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$106.66
|
Rate for Payer: Fidelis Medicare Advantage |
$194.78
|
Rate for Payer: Group Health Inc Commercial |
$92.75
|
Rate for Payer: Group Health Inc Medicare |
$64.92
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$92.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.58
|
|
ACUMED SCREW CORTICAL 3.5
|
Facility
IP
|
$185.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205658
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$92.75 |
Max. Negotiated Rate |
$92.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$92.75
|
|
ACUMED SCREW CORTICAL 3.5X60MM
|
Facility
OP
|
$620.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205659
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$651.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$341.00
|
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 |
$310.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$356.50
|
Rate for Payer: Fidelis Medicare Advantage |
$651.00
|
Rate for Payer: Group Health Inc Commercial |
$310.00
|
Rate for Payer: Group Health Inc Medicare |
$217.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$310.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$403.00
|
|
ACUMED SCREW CORTICAL 3.5X60MM
|
Facility
IP
|
$620.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205659
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$310.00 |
Max. Negotiated Rate |
$310.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$310.00
|
|
ACUMED SCRW CORT 2.7
|
Facility
OP
|
$162.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205657
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$56.88 |
Max. Negotiated Rate |
$170.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.38
|
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 |
$81.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$93.44
|
Rate for Payer: Fidelis Medicare Advantage |
$170.62
|
Rate for Payer: Group Health Inc Commercial |
$81.25
|
Rate for Payer: Group Health Inc Medicare |
$56.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$81.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.62
|
|
ACUMED SCRW CORT 2.7
|
Facility
IP
|
$162.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205657
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$81.25 |
Max. Negotiated Rate |
$81.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$81.25
|
|
ACUMED SCRW LCK 2.7
|
Facility
IP
|
$262.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205660
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$131.25 |
Max. Negotiated Rate |
$131.25 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$131.25
|
|
ACUMED SCRW LCK 2.7
|
Facility
OP
|
$262.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205660
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$91.88 |
Max. Negotiated Rate |
$275.62 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.38
|
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 |
$131.25
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$150.94
|
Rate for Payer: Fidelis Medicare Advantage |
$275.62
|
Rate for Payer: Group Health Inc Commercial |
$131.25
|
Rate for Payer: Group Health Inc Medicare |
$91.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$131.25
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.62
|
|
ACUMED SCRW LCKNG 3.5X
|
Facility
OP
|
$317.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208165
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$111.12 |
Max. Negotiated Rate |
$339.17 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.62
|
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 |
$158.75
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.56
|
Rate for Payer: Fidelis Medicare Advantage |
$333.38
|
Rate for Payer: Group Health Inc Commercial |
$158.75
|
Rate for Payer: Group Health Inc Medicare |
$111.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$158.75
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.38
|
|
ACUMED SCRW LCKNG 3.5X
|
Facility
IP
|
$317.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
40208165
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$158.75 |
Max. Negotiated Rate |
$158.75 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$158.75
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
IP
|
$20,976.95
|
|
Service Code
|
MS-DRG 880
|
Min. Negotiated Rate |
$905.00 |
Max. Negotiated Rate |
$20,976.95 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,859.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,565.64
|
Rate for Payer: Aetna Government |
$20,565.64
|
Rate for Payer: Brighton Health Commercial |
$13,841.70
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,976.95
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,484.99
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,604.12
|
Rate for Payer: Elderplan Medicare Advantage |
$19,537.36
|
Rate for Payer: EmblemHealth Commercial |
$905.00
|
Rate for Payer: Fidelis Medicare Advantage |
$20,565.64
|
Rate for Payer: Group Health Inc Commercial |
$20,565.64
|
Rate for Payer: Group Health Inc Medicare |
$20,565.64
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$20,565.64
|
Rate for Payer: Healthfirst Medicare Advantage |
$9,563.02
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$20,565.64
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,565.64
|
Rate for Payer: Wellcare Medicare |
$19,537.36
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
IP
|
$28,376.07
|
|
Service Code
|
MS-DRG 289
|
Min. Negotiated Rate |
$12,671.30 |
Max. Negotiated Rate |
$28,376.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,788.69
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,819.68
|
Rate for Payer: Aetna Government |
$27,819.68
|
Rate for Payer: Brighton Health Commercial |
$21,426.65
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,376.07
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,518.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,058.88
|
Rate for Payer: Elderplan Medicare Advantage |
$26,428.70
|
Rate for Payer: EmblemHealth Commercial |
$12,671.30
|
Rate for Payer: Fidelis Medicare Advantage |
$27,819.68
|
Rate for Payer: Group Health Inc Commercial |
$27,819.68
|
Rate for Payer: Group Health Inc Medicare |
$27,819.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$27,819.68
|
Rate for Payer: Healthfirst Medicare Advantage |
$12,936.15
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$27,819.68
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,819.68
|
Rate for Payer: Wellcare Medicare |
$26,428.70
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
IP
|
$44,778.52
|
|
Service Code
|
MS-DRG 288
|
Min. Negotiated Rate |
$20,127.98 |
Max. Negotiated Rate |
$44,778.52 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38,233.79
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43,285.97
|
Rate for Payer: Aetna Government |
$43,285.97
|
Rate for Payer: Brighton Health Commercial |
$37,598.50
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44,151.69
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44,778.52
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$36,953.15
|
Rate for Payer: Elderplan Medicare Advantage |
$41,121.67
|
Rate for Payer: EmblemHealth Commercial |
$22,235.00
|
Rate for Payer: Fidelis Medicare Advantage |
$43,285.97
|
Rate for Payer: Group Health Inc Commercial |
$43,285.97
|
Rate for Payer: Group Health Inc Medicare |
$43,285.97
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$43,285.97
|
Rate for Payer: Healthfirst Medicare Advantage |
$20,127.98
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$43,285.97
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43,285.97
|
Rate for Payer: Wellcare Medicare |
$41,121.67
|
|