|
SCI WALLFLEX STENT 22MMX27X90MM
|
Facility
OP
|
$5,170.92
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
40005446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.18 |
| Max. Negotiated Rate |
$5,429.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,844.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$398.18
|
| Rate for Payer: Aetna Government |
$398.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,585.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,973.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,429.47
|
| Rate for Payer: Group Health Inc Commercial |
$2,585.46
|
| Rate for Payer: Group Health Inc Medicare |
$1,809.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,585.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,585.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,361.10
|
|
|
SCI WALLFLEX STENT 22MMX27X90MM
|
Facility
IP
|
$5,170.92
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
40005446
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,585.46 |
| Max. Negotiated Rate |
$2,585.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,585.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,585.46
|
|
|
SCLERECTOMY
|
Facility
OP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66160
|
| Hospital Charge Code |
40072540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,046.21 |
| Max. Negotiated Rate |
$3,061.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,694.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,694.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,046.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,290.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,398.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,694.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,398.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,694.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,694.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,694.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,162.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,694.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,155.90
|
| Rate for Payer: Wellcare Medicare |
$2,560.14
|
|
|
SCLEROTX FLUID COLLECTION
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 49185
|
| Hospital Charge Code |
41103928
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Brighton Health Commercial |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,312.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,687.40
|
| Rate for Payer: Group Health Inc Medicare |
$1,687.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
SCOPE LITHOVUE
|
Facility
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1474
|
| Hospital Charge Code |
64907500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,875.00 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,875.00
|
|
|
SCOPE LITHOVUE
|
Facility
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS C1474
|
| Hospital Charge Code |
64907500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.50 |
| Max. Negotiated Rate |
$3,937.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,062.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,875.00
|
| Rate for Payer: Aetna Government |
$1,875.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,875.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,156.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,937.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,875.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,312.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,875.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,437.50
|
|
|
SCOPOLAMINE 0.25% SOLUTION
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41640845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
SCOPOLAMINE 0.25% SOLUTION
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41650845
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
SCOPOLAMINE PATCH
|
Facility
OP
|
$22.42
|
|
| Hospital Charge Code |
41655255
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.21
|
| Rate for Payer: Aetna Government |
$11.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.25
|
| Rate for Payer: Group Health Inc Commercial |
$11.21
|
| Rate for Payer: Group Health Inc Medicare |
$7.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.57
|
|
|
SCOPOLAMINE PATCH
|
Facility
OP
|
$22.42
|
|
| Hospital Charge Code |
41645255
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.21
|
| Rate for Payer: Aetna Government |
$11.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.25
|
| Rate for Payer: Group Health Inc Commercial |
$11.21
|
| Rate for Payer: Group Health Inc Medicare |
$7.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.57
|
|
|
SCR/2.0X4MM LCKING CR PN
|
Facility
OP
|
$225.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.83 |
| Max. Negotiated Rate |
$236.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.88
|
| 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 |
$112.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.49
|
| Rate for Payer: Group Health Inc Commercial |
$112.62
|
| Rate for Payer: Group Health Inc Medicare |
$78.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.40
|
|
|
SCR/2.0X4MM LCKING CR PN
|
Facility
IP
|
$225.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.62 |
| Max. Negotiated Rate |
$112.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.62
|
|
|
SCR/2.0X6.0MM BONE CROSS PIN
|
Facility
OP
|
$85.68
|
|
| Hospital Charge Code |
40005869
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$68.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.26
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$29.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
|
|
SCR/2.0X6MM LCKING CROSS PIN
|
Facility
OP
|
$312.76
|
|
| Hospital Charge Code |
40005870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$250.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.38
|
| Rate for Payer: Aetna Government |
$156.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$250.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$212.68
|
| Rate for Payer: Group Health Inc Commercial |
$156.38
|
| Rate for Payer: Group Health Inc Medicare |
$109.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.38
|
|
|
SCR/2.0X8MM LCKING CROSS PIN
|
Facility
OP
|
$312.76
|
|
| Hospital Charge Code |
40005860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$250.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.38
|
| Rate for Payer: Aetna Government |
$156.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$250.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$212.68
|
| Rate for Payer: Group Health Inc Commercial |
$156.38
|
| Rate for Payer: Group Health Inc Medicare |
$109.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.38
|
|
|
SCR DEP NEG, NO PLAN REQD
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8510
|
| Hospital Charge Code |
30307868
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
SCR DEP POS, NO PLAN DOC RING
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8511
|
| Hospital Charge Code |
30307869
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
SCRE 3.5MM CORTICAL LOCKING 22MM
|
Facility
OP
|
$286.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$300.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$157.30
|
| 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 |
$143.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.30
|
| Rate for Payer: Group Health Inc Commercial |
$143.00
|
| Rate for Payer: Group Health Inc Medicare |
$100.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.90
|
|
|
SCRE 3.5MM CORTICAL LOCKING 22MM
|
Facility
IP
|
$286.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40007553
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.00
|
|
|
SCREEN DEPRESSION PERFORMED
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 3725F
|
| Hospital Charge Code |
30300372
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$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
|
|
|
SCREEN HLTHY ETOH USE
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2197
|
| Hospital Charge Code |
30300325
|
|
Hospital Revenue Code
|
929
|
| 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: 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
|
|
|
SCREENING MAMMO BILAT INC CAD
|
Facility
OP
|
$402.90
|
|
|
Service Code
|
HCPCS 77067 TC
|
| Hospital Charge Code |
41104718
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$102.73 |
| Max. Negotiated Rate |
$322.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$221.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$201.45
|
| Rate for Payer: Aetna Government |
$201.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$322.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$273.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.73
|
| Rate for Payer: Group Health Inc Commercial |
$201.45
|
| Rate for Payer: Group Health Inc Medicare |
$141.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.14
|
|
|
SCREEN MAMMO DOC REV
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 3014F
|
| Hospital Charge Code |
30300375
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$2,915.00 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$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
|
|
|
SCREEN UNHLTHY ETOH USE
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2196
|
| Hospital Charge Code |
30300324
|
|
Hospital Revenue Code
|
929
|
| 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: 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
|
|
|
SCREW
|
Facility
IP
|
$487.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203571
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.90
|
|
