|
SP CONSC. SEDAT. EACH ADD'L 15MIN
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 99145
|
| Hospital Charge Code |
30102477
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,455.04 |
| Max. Negotiated Rate |
$3,325.80 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$3,325.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,826.93
|
| 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 CONTRAST INJ CK VEN ACCESS
|
Facility
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 36598 TC
|
| Hospital Charge Code |
41548029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$278.25
|
| Rate for Payer: Aetna Government |
$278.25
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| 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 |
$278.25
|
| Rate for Payer: Group Health Inc Medicare |
$194.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.25
|
|
|
SP CONTRAST VENOGRAM
|
Facility
OP
|
$1,032.38
|
|
|
Service Code
|
HCPCS 36005 TC
|
| Hospital Charge Code |
41542690
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$361.33 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$567.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$516.19
|
| Rate for Payer: Aetna Government |
$516.19
|
| 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 |
$516.19
|
| Rate for Payer: Group Health Inc Medicare |
$361.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$516.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$516.19
|
|
|
SP CONVERTION TO G-J TUBE
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 44373 TC
|
| Hospital Charge Code |
41547659
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,594.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,358.49
|
| Rate for Payer: Aetna Government |
$2,358.49
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| 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 |
$2,358.49
|
| Rate for Payer: Group Health Inc Medicare |
$1,650.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,358.49
|
|
|
SP CONVERT J-TUBE FR EXIST G-TUBE
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 43761 TC
|
| Hospital Charge Code |
41547655
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$391.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$355.72
|
| Rate for Payer: Aetna Government |
$355.72
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| 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 |
$355.72
|
| Rate for Payer: Group Health Inc Medicare |
$249.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.72
|
|
|
SP CRYOABLATION KIDNEY
|
Facility
OP
|
$25,481.20
|
|
|
Service Code
|
HCPCS 50593 TC
|
| Hospital Charge Code |
41561826
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$14,014.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,014.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,740.60
|
| Rate for Payer: Aetna Government |
$12,740.60
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| 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 |
$12,740.60
|
| Rate for Payer: Group Health Inc Medicare |
$8,918.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,740.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,740.60
|
|
|
SP CYSTOGRAM
|
Facility
OP
|
$605.55
|
|
|
Service Code
|
HCPCS 51600 TC
|
| Hospital Charge Code |
41542727
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.94 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$333.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302.78
|
| Rate for Payer: Aetna Government |
$302.78
|
| 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 |
$302.78
|
| Rate for Payer: Group Health Inc Medicare |
$211.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302.78
|
|
|
SP DENVER SHUNT
|
Facility
OP
|
$2,425.06
|
|
|
Service Code
|
HCPCS 49427 TC
|
| Hospital Charge Code |
41547447
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$848.77 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,333.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,212.53
|
| Rate for Payer: Aetna Government |
$1,212.53
|
| 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 |
$1,212.53
|
| Rate for Payer: Group Health Inc Medicare |
$848.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,212.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,212.53
|
|
|
SP DESCENDING THORACIC AORTA GRAF
|
Facility
OP
|
$6,768.48
|
|
|
Service Code
|
HCPCS 33875 TC
|
| Hospital Charge Code |
41547702
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,368.97 |
| Max. Negotiated Rate |
$3,722.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,722.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,384.24
|
| Rate for Payer: Aetna Government |
$3,384.24
|
| 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: Group Health Inc Commercial |
$3,384.24
|
| Rate for Payer: Group Health Inc Medicare |
$2,368.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,384.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,384.24
|
|
|
SP DILATION URETERS
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 52351 TC
|
| Hospital Charge Code |
41542737
|
|
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 DILN EXISTING NEPHROSTOMY
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 50436
|
| Hospital Charge Code |
41546548
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.63 |
| Max. Negotiated Rate |
$4,031.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$4,031.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
SP DILN NEPHROSTOMY NEW ACCESS
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 50437
|
| Hospital Charge Code |
41546549
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$261.35 |
| Max. Negotiated Rate |
$4,571.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$4,031.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$261.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
SP DISCECTOMY, PERCUTANEOUS
|
Facility
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 62287 TC
|
| Hospital Charge Code |
41549864
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,822.62 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,864.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,603.74
|
| Rate for Payer: Aetna Government |
$2,603.74
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$2,603.74
|
| Rate for Payer: Group Health Inc Medicare |
$1,822.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,603.74
|
|
|
SP DRAINAGE BLADDER
|
Facility
OP
|
$2,752.98
|
|
|
Service Code
|
HCPCS 51101 TC
|
| Hospital Charge Code |
41547643
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$963.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,514.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,376.49
|
| Rate for Payer: Aetna Government |
$1,376.49
|
| Rate for Payer: Cash Price |
$1,209.08
|
| Rate for Payer: Cash Price |
$1,209.08
|
| 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 |
$1,376.49
|
| Rate for Payer: Group Health Inc Medicare |
$963.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,376.49
|
|
|
SP DUP-SCAN HEMO COMPL BI STD
|
Facility
OP
|
$692.43
|
|
|
Service Code
|
HCPCS 93986
|
| Hospital Charge Code |
41561888
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$101.71 |
| Max. Negotiated Rate |
$553.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$553.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$470.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$127.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
SP DUP-SCAN HEMO COMPL STD UNILAT
|
Facility
OP
|
$477.10
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
41201179
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$226.70 |
| Max. Negotiated Rate |
$381.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$381.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$324.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$276.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
SP EACH ADDITIONAL CYST
|
Facility
OP
|
$248.06
|
|
|
Service Code
|
HCPCS 19001 TC
|
| Hospital Charge Code |
41549615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$124.03
|
| Rate for Payer: Aetna Government |
$124.03
|
| 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 |
$124.03
|
| Rate for Payer: Group Health Inc Medicare |
$86.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.03
|
|
|
SPEARS SURGICAL WECKCELL
|
Facility
OP
|
$3.82
|
|
| Hospital Charge Code |
64904342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.91
|
| Rate for Payer: Aetna Government |
$1.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.60
|
| Rate for Payer: Group Health Inc Commercial |
$1.91
|
| Rate for Payer: Group Health Inc Medicare |
$1.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.91
|
|
|
SPECIAL NURSING DAY SHIFT
|
Facility
OP
|
$1,154.20
|
|
| Hospital Charge Code |
40209998
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$403.97 |
| Max. Negotiated Rate |
$923.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$634.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$577.10
|
| Rate for Payer: Aetna Government |
$577.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$923.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$784.86
|
| Rate for Payer: Group Health Inc Commercial |
$577.10
|
| Rate for Payer: Group Health Inc Medicare |
$403.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$577.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$577.10
|
|
|
SPECIAL NURSING EVENING SHIFT
|
Facility
OP
|
$1,271.50
|
|
| Hospital Charge Code |
40209997
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$445.02 |
| Max. Negotiated Rate |
$1,017.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$699.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$635.75
|
| Rate for Payer: Aetna Government |
$635.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,017.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$864.62
|
| Rate for Payer: Group Health Inc Commercial |
$635.75
|
| Rate for Payer: Group Health Inc Medicare |
$445.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$635.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$635.75
|
|
|
SPECIMEN INFECT AGNT CONCNTJ
|
Facility
OP
|
$16.70
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
40614335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$10.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.68
|
| Rate for Payer: Aetna Government |
$6.68
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.99
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.68
|
| Rate for Payer: EmblemHealth Commercial |
$6.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.95
|
| Rate for Payer: Group Health Inc Commercial |
$6.68
|
| Rate for Payer: Group Health Inc Medicare |
$6.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.68
|
| Rate for Payer: Healthfirst QHP |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.34
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
SPECTRA
|
Facility
OP
|
$19,352.50
|
|
| Hospital Charge Code |
64904542
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$6,773.38 |
| Max. Negotiated Rate |
$15,482.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,643.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,676.25
|
| Rate for Payer: Aetna Government |
$9,676.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,482.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,159.70
|
| Rate for Payer: Group Health Inc Commercial |
$9,676.25
|
| Rate for Payer: Group Health Inc Medicare |
$6,773.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,676.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,676.25
|
|
|
SPECTRANETICS PTCA BALLOON
|
Facility
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66572919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.00
|
|
|
SPECTRANETICS PTCA BALLOON
|
Facility
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66572919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$1,837.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$962.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$875.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,006.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,837.50
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,137.50
|
|
|
SPECULA,OTOSCOPE,4.25MM,UNIV,K
|
Facility
OP
|
$0.06
|
|
| Hospital Charge Code |
64902415
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
|
