|
SPECULA OTOSCOPE KLEENSPEC
|
Facility
OP
|
$0.16
|
|
| Hospital Charge Code |
64903504
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
|
|
SPECULA OTOSCOPE PEDS 2.75 MM
|
Facility
OP
|
$0.06
|
|
| Hospital Charge Code |
64902007
|
|
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
|
|
|
SPECULUM,VAGINAL,LARGE,DISPOS
|
Facility
OP
|
$0.65
|
|
| Hospital Charge Code |
64901454
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
|
|
SPECULUM,VAGINAL,MEDIUM,DISPOS
|
Facility
OP
|
$0.53
|
|
| Hospital Charge Code |
64901149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
|
|
SPECULUM,VAGINAL SM DISPOSABLE NS
|
Facility
OP
|
$0.53
|
|
| Hospital Charge Code |
64901146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
|
|
SPEECH AID PROSTHESIS, ADULT
|
Facility
OP
|
$2,846.00
|
|
|
Service Code
|
HCPCS D5953
|
| Hospital Charge Code |
42301335
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$996.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,565.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,943.35
|
| Rate for Payer: Aetna Government |
$1,943.35
|
| 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 |
$1,423.00
|
| Rate for Payer: Group Health Inc Medicare |
$996.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,423.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,423.00
|
|
|
SPEECH AID PROSTHESIS, MODIFICATI
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
HCPCS D5960
|
| Hospital Charge Code |
42301360
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$177.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,295.90
|
| Rate for Payer: Aetna Government |
$1,295.90
|
| 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: Group Health Inc Commercial |
$161.00
|
| Rate for Payer: Group Health Inc Medicare |
$112.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.00
|
|
|
SPEECH AID PROSTHESIS, PEDIATRIC
|
Facility
OP
|
$753.00
|
|
|
Service Code
|
HCPCS D5952
|
| Hospital Charge Code |
42301330
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$263.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$414.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,023.18
|
| Rate for Payer: Aetna Government |
$1,023.18
|
| 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 |
$376.50
|
| Rate for Payer: Group Health Inc Medicare |
$263.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.50
|
|
|
SPEECH AUDIOMETRY COMPLETE
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
30304751
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.28 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
SPEECH AUDIOMETRY THRESHOLD
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
42003005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
SPEECH/HEARING THERAPY
|
Facility
OP
|
$228.65
|
|
|
Service Code
|
HCPCS 92507
|
| Hospital Charge Code |
30307901
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.82
|
| Rate for Payer: Aetna Government |
$52.82
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.42
|
| Rate for Payer: Group Health Inc Commercial |
$114.32
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.25
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
SPEECH-LANG THERAPY 31-45 MIN.
|
Facility
OP
|
$228.65
|
|
|
Service Code
|
HCPCS 92507 GN
|
| Hospital Charge Code |
41904821
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.32
|
| Rate for Payer: Aetna Government |
$114.32
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$114.32
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.32
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
SP ELBOW ARTHROGRAM
|
Facility
OP
|
$478.25
|
|
|
Service Code
|
HCPCS 24220 TC
|
| Hospital Charge Code |
41547465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$263.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$239.12
|
| Rate for Payer: Aetna Government |
$239.12
|
| 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 |
$239.12
|
| Rate for Payer: Group Health Inc Medicare |
$167.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.12
|
|
|
SP EMBOLI BLEED
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37244 TC
|
| Hospital Charge Code |
41104009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$16,505.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,505.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,005.15
|
| Rate for Payer: Aetna Government |
$15,005.15
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$15,005.15
|
| Rate for Payer: Group Health Inc Medicare |
$10,503.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,005.15
|
|
|
SP EMBOLI ORGAN
|
Facility
OP
|
$30,948.00
|
|
|
Service Code
|
HCPCS 37243 TC
|
| Hospital Charge Code |
41104007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$17,021.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,021.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,474.00
|
| Rate for Payer: Aetna Government |
$15,474.00
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$15,474.00
|
| Rate for Payer: Group Health Inc Medicare |
$10,831.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,474.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,474.00
|
|
|
SP EMBOLIZATION (NEURO)
|
Facility
OP
|
$3,193.63
|
|
|
Service Code
|
HCPCS 61624 TC
|
| Hospital Charge Code |
41542743
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,117.77 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,756.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,596.82
|
| Rate for Payer: Aetna Government |
$1,596.82
|
| 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 |
$1,596.82
|
| Rate for Payer: Group Health Inc Medicare |
$1,117.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,596.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,596.82
|
|
|
SP EMBOLIZ. EXTRACRAN. HEAD &NECK
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 61626 TC
|
| Hospital Charge Code |
41549742
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$16,505.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,505.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,005.15
|
| Rate for Payer: Aetna Government |
$15,005.15
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$15,005.15
|
| Rate for Payer: Group Health Inc Medicare |
$10,503.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,005.15
|
|
|
SP EMB/THROMB-AXILL,BRACH-ARMINCI
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 34101 TC
|
| Hospital Charge Code |
41547715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$7,656.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,656.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,960.35
|
| Rate for Payer: Aetna Government |
$6,960.35
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| 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 |
$6,960.35
|
| Rate for Payer: Group Health Inc Medicare |
$4,872.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,960.35
|
|
|
SP EMB/THROM,FEMOR,AORT-IL ART,LE
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 34201 TC
|
| Hospital Charge Code |
41547717
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$7,656.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,656.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,960.35
|
| Rate for Payer: Aetna Government |
$6,960.35
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| 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 |
$6,960.35
|
| Rate for Payer: Group Health Inc Medicare |
$4,872.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,960.35
|
|
|
SP EMB/THROM-REN,CEL,AORILL,ABD I
|
Facility
OP
|
$2,061.05
|
|
|
Service Code
|
HCPCS 34151 TC
|
| Hospital Charge Code |
41547716
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.37 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,133.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,030.52
|
| Rate for Payer: Aetna Government |
$1,030.52
|
| 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 |
$1,030.52
|
| Rate for Payer: Group Health Inc Medicare |
$721.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,030.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,030.52
|
|
|
SP ENDOLUMINAL BX URTR RNL PLVS
|
Facility
OP
|
$2,804.37
|
|
|
Service Code
|
HCPCS 50606
|
| Hospital Charge Code |
41542909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$147.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.44
|
| Rate for Payer: Aetna Government |
$192.44
|
| 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 |
$147.39
|
| 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 |
$163.77
|
|
|
SP ENDOVENOUS ABLAT THERAPY
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
41200615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.33 |
| Max. Negotiated Rate |
$4,196.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$310.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$344.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
SP ENDOVENOUS LASER ABLATION, 1ST
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36478 TC
|
| Hospital Charge Code |
41561844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,616.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| 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 |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
|
|
SP ENDOVENOUS LASER ABLATION ADD
|
Facility
OP
|
$6,231.85
|
|
|
Service Code
|
HCPCS 36479 TC
|
| Hospital Charge Code |
41561845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,181.15 |
| Max. Negotiated Rate |
$3,427.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,427.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,115.92
|
| Rate for Payer: Aetna Government |
$3,115.92
|
| 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 |
$3,115.92
|
| Rate for Payer: Group Health Inc Medicare |
$2,181.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,115.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,115.92
|
|
|
SP ENDOVENOUS MCHNCHEM 1ST VEIN
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36473 TC
|
| Hospital Charge Code |
41563235
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,616.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| 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 |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
|
