|
CONJUGATE+HEP B VFC DIP,TET,PERT
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650265
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
CONMED 6.0X16.5MM DUET SUTUR ANCH
|
Facility
|
IP
|
$1,033.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.56 |
| Max. Negotiated Rate |
$516.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$516.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$516.56
|
|
|
CONMED 6.0X16.5MM DUET SUTUR ANCH
|
Facility
|
OP
|
$1,033.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205651
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,084.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$568.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$619.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$516.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$594.05
|
| Rate for Payer: EmblemHealth Commercial |
$516.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,084.79
|
| Rate for Payer: Group Health Inc Commercial |
$516.56
|
| Rate for Payer: Group Health Inc Medicare |
$361.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$516.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$516.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$671.53
|
|
|
CONMED ANCHOR BIO PRE-LOAD BIOABS
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$262.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$150.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$125.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.75
|
| Rate for Payer: EmblemHealth Commercial |
$125.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.50
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.50
|
|
|
CONMED ANCHOR BIO PRE-LOAD BIOABS
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
CONMED ANCHOR BIO PRE-LOAD BIOABS
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
40009330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.00
|
| Rate for Payer: Aetna Government |
$125.00
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
CONMED BLADE OSCIL INTRA ORAL
|
Facility
|
OP
|
$296.00
|
|
| Hospital Charge Code |
40203371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$236.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$162.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$148.00
|
| Rate for Payer: Aetna Government |
$148.00
|
| Rate for Payer: Brighton Health Commercial |
$222.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$236.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.28
|
| Rate for Payer: Group Health Inc Commercial |
$148.00
|
| Rate for Payer: Group Health Inc Medicare |
$103.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.00
|
|
|
CONMED BLADE OSCIL INTRA ORAL
|
Facility
|
OP
|
$296.00
|
|
| Hospital Charge Code |
40009355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$236.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$162.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$148.00
|
| Rate for Payer: Aetna Government |
$148.00
|
| Rate for Payer: Brighton Health Commercial |
$222.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$236.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.28
|
| Rate for Payer: Group Health Inc Commercial |
$148.00
|
| Rate for Payer: Group Health Inc Medicare |
$103.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.00
|
|
|
CONMED LINVATEC BIO ANCHR3.5X10.5
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.00 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.00
|
|
|
CONMED LINVATEC BIO ANCHR3.5X10.5
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$480.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$251.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$274.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$229.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$263.35
|
| Rate for Payer: EmblemHealth Commercial |
$229.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$480.90
|
| Rate for Payer: Group Health Inc Commercial |
$229.00
|
| Rate for Payer: Group Health Inc Medicare |
$160.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.70
|
|
|
CONMED V- CARE SM VAGINAL C
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
40208126
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.00
|
| Rate for Payer: Aetna Government |
$50.00
|
| Rate for Payer: Brighton Health Commercial |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
CONNECTING NUT - SHORT - M8
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
64905263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.00
|
| Rate for Payer: Aetna Government |
$30.00
|
| Rate for Payer: Brighton Health Commercial |
$45.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.80
|
| Rate for Payer: Group Health Inc Commercial |
$30.00
|
| Rate for Payer: Group Health Inc Medicare |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.00
|
|
|
CONNECTING ROD EXT FIX 100
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.00
|
|
|
CONNECTING ROD EXT FIX 100
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$249.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$142.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.85
|
| Rate for Payer: EmblemHealth Commercial |
$119.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$249.90
|
| Rate for Payer: Group Health Inc Commercial |
$119.00
|
| Rate for Payer: Group Health Inc Medicare |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.70
|
|
|
CONNECTING ROD EXT FIX 150
|
Facility
|
IP
|
$586.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.12 |
| Max. Negotiated Rate |
$293.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.12
|
|
|
CONNECTING ROD EXT FIX 150
|
Facility
|
OP
|
$586.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$615.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$322.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$351.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$293.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$337.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$615.56
|
| Rate for Payer: Group Health Inc Commercial |
$293.12
|
| Rate for Payer: Group Health Inc Medicare |
$205.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$381.06
|
|
|
CONNECTING ROD EXT FIX 200
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.50
|
|
|
CONNECTING ROD EXT FIX 200
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901256
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$668.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$350.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$382.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$366.28
|
| Rate for Payer: EmblemHealth Commercial |
$318.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$668.85
|
| Rate for Payer: Group Health Inc Commercial |
$318.50
|
| Rate for Payer: Group Health Inc Medicare |
$222.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$414.05
|
|
|
CONNECTION SCREW FOR NCB PLT
|
Facility
|
IP
|
$311.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.74 |
| Max. Negotiated Rate |
$155.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.74
|
|
|
CONNECTION SCREW FOR NCB PLT
|
Facility
|
OP
|
$311.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.02 |
| Max. Negotiated Rate |
$327.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$186.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$179.10
|
| Rate for Payer: EmblemHealth Commercial |
$155.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$327.05
|
| Rate for Payer: Group Health Inc Commercial |
$155.74
|
| Rate for Payer: Group Health Inc Medicare |
$109.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.46
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$32,943.62
|
|
|
Service Code
|
MSDRG 546
|
| Min. Negotiated Rate |
$10,284.00 |
| Max. Negotiated Rate |
$32,943.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,683.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,959.00
|
| Rate for Payer: Aetna Government |
$23,959.00
|
| Rate for Payer: Brighton Health Commercial |
$17,389.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,438.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,710.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,091.37
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,761.05
|
| Rate for Payer: EmblemHealth Commercial |
$10,284.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,959.00
|
| Rate for Payer: Group Health Inc Commercial |
$23,959.00
|
| Rate for Payer: Group Health Inc Medicare |
$23,959.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,959.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,140.94
|
| Rate for Payer: Humana Medicare |
$32,943.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,959.00
|
| Rate for Payer: United Healthcare Commercial |
$23,850.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,959.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,959.00
|
| Rate for Payer: Wellcare Medicare |
$22,761.05
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$57,615.25
|
|
|
Service Code
|
MSDRG 545
|
| Min. Negotiated Rate |
$19,484.43 |
| Max. Negotiated Rate |
$57,615.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36,762.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41,902.00
|
| Rate for Payer: Aetna Government |
$41,902.00
|
| Rate for Payer: Brighton Health Commercial |
$36,151.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42,740.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43,055.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35,530.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$39,806.90
|
| Rate for Payer: EmblemHealth Commercial |
$21,379.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$41,902.00
|
| Rate for Payer: Group Health Inc Commercial |
$41,902.00
|
| Rate for Payer: Group Health Inc Medicare |
$41,902.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41,902.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,484.43
|
| Rate for Payer: Humana Medicare |
$57,615.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41,902.00
|
| Rate for Payer: United Healthcare Commercial |
$49,582.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41,902.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41,902.00
|
| Rate for Payer: Wellcare Medicare |
$39,806.90
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$25,774.18
|
|
|
Service Code
|
MSDRG 547
|
| Min. Negotiated Rate |
$6,974.91 |
| Max. Negotiated Rate |
$25,774.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,993.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,744.86
|
| Rate for Payer: Aetna Government |
$18,744.86
|
| Rate for Payer: Brighton Health Commercial |
$11,794.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,119.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,217.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,732.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,807.62
|
| Rate for Payer: EmblemHealth Commercial |
$6,974.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,744.86
|
| Rate for Payer: Group Health Inc Commercial |
$18,744.86
|
| Rate for Payer: Group Health Inc Medicare |
$18,744.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,744.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,716.36
|
| Rate for Payer: Humana Medicare |
$25,774.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,744.86
|
| Rate for Payer: United Healthcare Commercial |
$16,372.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,744.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,744.86
|
| Rate for Payer: Wellcare Medicare |
$17,807.62
|
|
|
CONNECTOR 5-1 STRAIGHT
|
Facility
|
OP
|
$0.44
|
|
| Hospital Charge Code |
64901683
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
|
|
CONNECTOR BAR
|
Facility
|
IP
|
$1,276.00
|
|
|
Service Code
|
HCPCS D6920
|
| Hospital Charge Code |
42303329
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
