|
INSJ BREAST IMPLT SM D MAST
|
Facility
|
OP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 19340
|
| Hospital Charge Code |
40000260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$11,896.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,541.13
|
| Rate for Payer: Aetna Government |
$7,541.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,278.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,278.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,278.79
|
| Rate for Payer: Brighton Health Commercial |
$11,896.84
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,541.13
|
| 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 |
$7,541.13
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,409.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,711.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,541.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,711.61
|
| Rate for Payer: Group Health Inc Commercial |
$7,541.13
|
| Rate for Payer: Group Health Inc Medicare |
$7,541.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,931.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,541.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,409.96
|
| Rate for Payer: Healthfirst QHP |
$7,541.13
|
| Rate for Payer: Humana Medicare |
$7,691.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,541.13
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,541.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,541.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,032.90
|
| Rate for Payer: Wellcare Medicare |
$7,164.07
|
|
|
INSJ BREAST IMPLT SM D MAST
|
Facility
|
IP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 19340
|
| Hospital Charge Code |
40000260
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,541.13
|
|
|
INSJ BREAST IMPT SM D MAST
|
Facility
|
OP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 19340
|
| Hospital Charge Code |
40013227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$11,896.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,541.13
|
| Rate for Payer: Aetna Government |
$7,541.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,278.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,278.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,278.79
|
| Rate for Payer: Brighton Health Commercial |
$11,896.84
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Cash Price |
$7,541.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,541.13
|
| 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 |
$7,541.13
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,409.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,711.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,541.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,711.61
|
| Rate for Payer: Group Health Inc Commercial |
$7,541.13
|
| Rate for Payer: Group Health Inc Medicare |
$7,541.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,931.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,541.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,409.96
|
| Rate for Payer: Healthfirst QHP |
$7,541.13
|
| Rate for Payer: Humana Medicare |
$7,691.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,541.13
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,541.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,541.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,032.90
|
| Rate for Payer: Wellcare Medicare |
$7,164.07
|
|
|
INSJ BREAST IMPT SM D MAST
|
Facility
|
IP
|
$15,862.45
|
|
|
Service Code
|
HCPCS 19340
|
| Hospital Charge Code |
40013227
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$7,541.13
|
|
|
INSJ SUBQ CAR RHYTHM MNTR
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
66523704
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
INSJ SUBQ CAR RHYTHM MNTR
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
66523704
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$17,358.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,824.59
|
| Rate for Payer: Aetna Government |
$9,824.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,877.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,877.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,877.21
|
| Rate for Payer: Brighton Health Commercial |
$17,358.94
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,824.59
|
| 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 |
$9,824.59
|
| Rate for Payer: EmblemHealth Commercial |
$9,824.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,350.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,743.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,824.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,743.89
|
| Rate for Payer: Group Health Inc Commercial |
$9,824.59
|
| Rate for Payer: Group Health Inc Medicare |
$9,824.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,824.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,350.90
|
| Rate for Payer: Healthfirst QHP |
$9,824.59
|
| Rate for Payer: Humana Medicare |
$10,021.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,824.59
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,824.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,824.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,859.67
|
| Rate for Payer: Wellcare Medicare |
$9,333.36
|
|
|
INSJ SUBQ CAR RHYTHM-MNTR
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
66573706
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
INSJ SUBQ CAR RHYTHM-MNTR
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33285
|
| Hospital Charge Code |
66573706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$17,358.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,824.59
|
| Rate for Payer: Aetna Government |
$9,824.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,877.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,877.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,877.21
|
| Rate for Payer: Brighton Health Commercial |
$17,358.94
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,824.59
|
| 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 |
$9,824.59
|
| Rate for Payer: EmblemHealth Commercial |
$9,824.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,350.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,743.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,824.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,743.89
|
| Rate for Payer: Group Health Inc Commercial |
$9,824.59
|
| Rate for Payer: Group Health Inc Medicare |
$9,824.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,824.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,350.90
|
| Rate for Payer: Healthfirst QHP |
$9,824.59
|
| Rate for Payer: Humana Medicare |
$10,021.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,824.59
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,824.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,824.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,859.67
|
| Rate for Payer: Wellcare Medicare |
$9,333.36
|
|
|
INS PERMA CATH.
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
40032015
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$726.47
|
|
|
INS PERMA CATH.
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
40032015
|
|
Hospital Revenue Code
|
360
|
| 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 |
$1,505.00
|
| 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
|
|
|
INS PERM SUBQ DEFIB SYSTEM
|
Facility
|
IP
|
$97,776.05
|
|
|
Service Code
|
HCPCS 33270
|
| Hospital Charge Code |
66573279
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$38,045.24
|
|
|
INS PERM SUBQ DEFIB SYSTEM
|
Facility
|
OP
|
$97,776.05
|
|
|
Service Code
|
HCPCS 33270
|
| Hospital Charge Code |
66573279
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$73,332.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,045.24
|
| Rate for Payer: Aetna Government |
$38,045.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26,631.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26,631.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,631.67
|
| Rate for Payer: Brighton Health Commercial |
$73,332.04
|
| Rate for Payer: Cash Price |
$38,045.24
|
| Rate for Payer: Cash Price |
$38,045.24
|
| Rate for Payer: Cash Price |
$38,045.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38,045.24
|
| 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 |
$38,045.24
|
| Rate for Payer: EmblemHealth Commercial |
$38,045.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32,338.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33,860.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,045.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,860.26
|
| Rate for Payer: Group Health Inc Commercial |
$38,045.24
|
| Rate for Payer: Group Health Inc Medicare |
$38,045.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48,888.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,045.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32,338.45
|
| Rate for Payer: Healthfirst QHP |
$38,045.24
|
| Rate for Payer: Humana Medicare |
$38,806.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,045.24
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,045.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,045.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,436.19
|
| Rate for Payer: Wellcare Medicare |
$36,142.98
|
|
|
INSPIRA SRX RE-STER SIZER, 400CC
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
40005956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.00
|
| Rate for Payer: Aetna Government |
$250.00
|
| Rate for Payer: Brighton Health Commercial |
$375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
|
INSRT PHALAG 2.5M OFFST-9P15PB01W
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,800.00
|
|
|
INSRT PHALAG 2.5M OFFST-9P15PB01W
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64906478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,980.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,160.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,070.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,800.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,780.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,800.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,260.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,800.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,800.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,340.00
|
|
|
INSRT/REDO SPINE N GENERATOR
|
Facility
|
IP
|
$88,193.38
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
40009673
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$35,909.47
|
|
|
INSRT/REDO SPINE N GENERATOR
|
Facility
|
OP
|
$88,193.38
|
|
|
Service Code
|
HCPCS 63685
|
| Hospital Charge Code |
40009673
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$66,145.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35,909.47
|
| Rate for Payer: Aetna Government |
$35,909.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25,136.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25,136.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25,136.63
|
| Rate for Payer: Brighton Health Commercial |
$66,145.04
|
| Rate for Payer: Cash Price |
$35,909.47
|
| Rate for Payer: Cash Price |
$35,909.47
|
| Rate for Payer: Cash Price |
$35,909.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,909.47
|
| 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 |
$35,909.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30,523.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31,959.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$35,909.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,959.43
|
| Rate for Payer: Group Health Inc Commercial |
$35,909.47
|
| Rate for Payer: Group Health Inc Medicare |
$35,909.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44,096.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35,909.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30,523.05
|
| Rate for Payer: Healthfirst QHP |
$35,909.47
|
| Rate for Payer: Humana Medicare |
$36,627.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35,909.47
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,909.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35,909.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28,727.58
|
| Rate for Payer: Wellcare Medicare |
$34,114.00
|
|
|
INSTAL SPINL CORD STIMULATOR
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 63610
|
| Hospital Charge Code |
40000095
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
INSTAL SPINL CORD STIMULATOR
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 63610
|
| Hospital Charge Code |
40000095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$3,905.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$3,905.61
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| Rate for Payer: Group Health Inc Commercial |
$2,232.80
|
| Rate for Payer: Group Health Inc Medicare |
$2,232.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
INST DISP ORTHO
|
Facility
|
OP
|
$1,750.00
|
|
| Hospital Charge Code |
64907195
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$962.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$875.00
|
| Rate for Payer: Aetna Government |
$875.00
|
| Rate for Payer: Brighton Health Commercial |
$1,312.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,190.00
|
| Rate for Payer: Group Health Inc Commercial |
$875.00
|
| Rate for Payer: Group Health Inc Medicare |
$612.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.00
|
|
|
INST ENDO GRASP 5MM
|
Facility
|
OP
|
$160.00
|
|
| Hospital Charge Code |
40206024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.00
|
| Rate for Payer: Aetna Government |
$80.00
|
| Rate for Payer: Brighton Health Commercial |
$120.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$128.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.80
|
| Rate for Payer: Group Health Inc Commercial |
$80.00
|
| Rate for Payer: Group Health Inc Medicare |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
|
|
INSTRUMENT BIOPSY MON 14GX10CM
|
Facility
|
OP
|
$78.40
|
|
| Hospital Charge Code |
64903167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$62.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.20
|
| Rate for Payer: Aetna Government |
$39.20
|
| Rate for Payer: Brighton Health Commercial |
$58.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.31
|
| Rate for Payer: Group Health Inc Commercial |
$39.20
|
| Rate for Payer: Group Health Inc Medicare |
$27.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.20
|
|
|
INSTRUMENT LIGASURE IMPACT 18CM
|
Facility
|
OP
|
$1,868.75
|
|
| Hospital Charge Code |
64904691
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$654.06 |
| Max. Negotiated Rate |
$1,495.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,027.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$934.38
|
| Rate for Payer: Aetna Government |
$934.38
|
| Rate for Payer: Brighton Health Commercial |
$1,401.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,495.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,270.75
|
| Rate for Payer: Group Health Inc Commercial |
$934.38
|
| Rate for Payer: Group Health Inc Medicare |
$654.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$934.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$934.38
|
|
|
INSTRUMENT SUCTION FRAZIER 10FR
|
Facility
|
OP
|
$0.19
|
|
| Hospital Charge Code |
64902945
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
|
|
INST UNIV BONE REP 3.2MM
|
Facility
|
IP
|
$1,157.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901555
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$578.66 |
| Max. Negotiated Rate |
$578.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.66
|
|
