|
SP ARTHROCENTESIS LARGE JOINT
|
Facility
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
30302002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$393.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
SP ARTHROCENTESIS MEDIUM JOINT
|
Facility
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 20605 TC
|
| Hospital Charge Code |
41548511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$275.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$432.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$393.00
|
| Rate for Payer: Aetna Government |
$393.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| 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 |
$393.00
|
| Rate for Payer: Group Health Inc Medicare |
$275.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$393.00
|
|
|
SP ART OCCLUSIVE DEVICE PLCMT
|
Facility
OP
|
$776.34
|
|
|
Service Code
|
HCPCS G0269 TC
|
| Hospital Charge Code |
41561953
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$271.72 |
| Max. Negotiated Rate |
$621.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$426.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Government |
$388.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$621.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$527.91
|
| Rate for Payer: Group Health Inc Commercial |
$388.17
|
| Rate for Payer: Group Health Inc Medicare |
$271.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$388.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$388.17
|
|
|
SP ASPIRATION BREAST CYST
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 19000 TC
|
| Hospital Charge Code |
41549614
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$646.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,016.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$923.79
|
| Rate for Payer: Aetna Government |
$923.79
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| 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 |
$923.79
|
| Rate for Payer: Group Health Inc Medicare |
$646.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$923.79
|
|
|
SP BALLOON DIL URETERAL STRICTURE
|
Facility
OP
|
$2,804.37
|
|
|
Service Code
|
HCPCS 50706
|
| Hospital Charge Code |
41542913
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$227.74
|
| Rate for Payer: Aetna Government |
$227.74
|
| 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: Fidelis CHP/HARP/Medicaid |
$189.04
|
| Rate for Payer: Group Health Inc Commercial |
$1,402.18
|
| Rate for Payer: Group Health Inc Medicare |
$981.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,402.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,402.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.05
|
|
|
SP BIATERAL LE VENOUS
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
41201170
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$173.96 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.96
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.29
|
|
|
SP BILAT LE ARTERIAL
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93925 TC
|
| Hospital Charge Code |
41201166
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$226.82 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.82
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.02
|
|
|
SP BIOPSY OF BREAST, NEEDLE
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 19100 TC
|
| Hospital Charge Code |
41546005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,455.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Government |
$2,078.62
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$2,078.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,078.62
|
|
|
SP BIOPSY SOFT TISSUE NECK/THROAT
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 21550 TC
|
| Hospital Charge Code |
41548758
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,455.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Government |
$2,078.62
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$2,078.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,078.62
|
|
|
SP BONE DEEP PERCUTANEOUS
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 20225 TC
|
| Hospital Charge Code |
41542796
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,455.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Government |
$2,078.62
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$2,078.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,078.62
|
|
|
SP BONE SUPERFICIAL PERC.
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 20220 TC
|
| Hospital Charge Code |
41542797
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,455.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Government |
$2,078.62
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$2,078.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,078.62
|
|
|
SP BRACHIO TRANSLUMBAR
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 0237T
|
| Hospital Charge Code |
41542772
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$15,005.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| 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 |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$12,721.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| Rate for Payer: Group Health Inc Commercial |
$12,721.98
|
| Rate for Payer: Group Health Inc Medicare |
$12,721.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
|
|
SP BRONCHOSCOPY W/STENT
|
Facility
OP
|
$16,477.50
|
|
|
Service Code
|
HCPCS 31631 TC
|
| Hospital Charge Code |
41546009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$9,062.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,062.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,238.75
|
| Rate for Payer: Aetna Government |
$8,238.75
|
| Rate for Payer: Cash Price |
$7,914.90
|
| Rate for Payer: Cash Price |
$7,914.90
|
| 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 |
$745.00
|
| Rate for Payer: Group Health Inc Commercial |
$8,238.75
|
| Rate for Payer: Group Health Inc Medicare |
$5,767.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,238.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,238.75
|
|
|
SP BRUSH BIOPSY,TRANSCATH,RENAL
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 52007 TC
|
| Hospital Charge Code |
41547651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$5,028.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,028.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,571.20
|
| Rate for Payer: Aetna Government |
$4,571.20
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| 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: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,571.20
|
| Rate for Payer: Group Health Inc Medicare |
$3,199.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,571.20
|
|
|
SP BYPASS GRAFT AORTA ILLIAC/BI I
|
Facility
OP
|
$4,892.55
|
|
|
Service Code
|
HCPCS 35637 TC
|
| Hospital Charge Code |
41547696
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,712.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,690.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,446.28
|
| Rate for Payer: Aetna Government |
$2,446.28
|
| 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 |
$2,446.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,712.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,446.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,446.28
|
|
|
SP BYPASS GRAFT AORTOFEMORAL
|
Facility
OP
|
$5,828.96
|
|
|
Service Code
|
HCPCS 35646 TC
|
| Hospital Charge Code |
41547799
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,040.14 |
| Max. Negotiated Rate |
$3,205.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,205.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,914.48
|
| Rate for Payer: Aetna Government |
$2,914.48
|
| 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 |
$2,914.48
|
| Rate for Payer: Group Health Inc Medicare |
$2,040.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,914.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,914.48
|
|
|
SP BYPASS GRAFT/FEMORAL POPLITEAL
|
Facility
OP
|
$3,741.15
|
|
|
Service Code
|
HCPCS 35656 TC
|
| Hospital Charge Code |
41547700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,309.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,057.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,870.58
|
| Rate for Payer: Aetna Government |
$1,870.58
|
| 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 |
$1,870.58
|
| Rate for Payer: Group Health Inc Medicare |
$1,309.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,870.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,870.58
|
|
|
SP BYPASS GRAFT/ILLEO FEMORAL
|
Facility
OP
|
$3,931.75
|
|
|
Service Code
|
HCPCS 35665 TC
|
| Hospital Charge Code |
41547701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,376.11 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,162.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,965.88
|
| Rate for Payer: Aetna Government |
$1,965.88
|
| 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: Group Health Inc Commercial |
$1,965.88
|
| Rate for Payer: Group Health Inc Medicare |
$1,376.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,965.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,965.88
|
|
|
SP BYPASS GRAFT SUBCLAVIAN
|
Facility
OP
|
$3,043.37
|
|
|
Service Code
|
HCPCS 35612 TC
|
| Hospital Charge Code |
41547697
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,065.18 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,673.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,521.68
|
| Rate for Payer: Aetna Government |
$1,521.68
|
| 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 |
$1,521.68
|
| Rate for Payer: Group Health Inc Medicare |
$1,065.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,521.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,521.68
|
|
|
SP BYPASS GRFT/SUBCLAVIAN/AXILLAR
|
Facility
OP
|
$3,187.33
|
|
|
Service Code
|
HCPCS 35616 TC
|
| Hospital Charge Code |
41547698
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,115.57 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,753.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,593.66
|
| Rate for Payer: Aetna Government |
$1,593.66
|
| 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 |
$1,593.66
|
| Rate for Payer: Group Health Inc Medicare |
$1,115.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,593.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,593.66
|
|
|
SP CAROTID COMPLETE
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93880 TC
|
| Hospital Charge Code |
41201160
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$171.37 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.37
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.41
|
|
|
SP CAROTID, EXTERNAL BI
|
Facility
OP
|
$1,872.25
|
|
|
Service Code
|
HCPCS 36227 TC
|
| Hospital Charge Code |
41102552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,029.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$936.12
|
| Rate for Payer: Aetna Government |
$936.12
|
| 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: Group Health Inc Commercial |
$936.12
|
| Rate for Payer: Group Health Inc Medicare |
$655.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$936.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$936.12
|
|
|
SP CAROTID, EXTERNAL UNI
|
Facility
OP
|
$1,872.25
|
|
|
Service Code
|
HCPCS 36227 TC
|
| Hospital Charge Code |
41102550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,029.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$936.12
|
| Rate for Payer: Aetna Government |
$936.12
|
| 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: Group Health Inc Commercial |
$936.12
|
| Rate for Payer: Group Health Inc Medicare |
$655.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$936.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$936.12
|
|
|
SP CAROTID, INTERNAL BI
|
Facility
OP
|
$1,147.78
|
|
|
Service Code
|
HCPCS 36228 TC
|
| Hospital Charge Code |
41103344
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$631.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$573.89
|
| Rate for Payer: Aetna Government |
$573.89
|
| 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: Group Health Inc Commercial |
$573.89
|
| Rate for Payer: Group Health Inc Medicare |
$401.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$573.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$573.89
|
|
|
SP CAROTID, INTERNAL UNI
|
Facility
OP
|
$1,147.78
|
|
|
Service Code
|
HCPCS 36228 TC
|
| Hospital Charge Code |
41103343
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$631.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$573.89
|
| Rate for Payer: Aetna Government |
$573.89
|
| 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: Group Health Inc Commercial |
$573.89
|
| Rate for Payer: Group Health Inc Medicare |
$401.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$573.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$573.89
|
|
