|
SP ENDOVENOUS MCHNCHEM ADDL
|
Facility
OP
|
$2,077.28
|
|
|
Service Code
|
HCPCS 36474 TC
|
| Hospital Charge Code |
41563236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$727.05 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,142.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,038.64
|
| Rate for Payer: Aetna Government |
$1,038.64
|
| 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 |
$1,038.64
|
| Rate for Payer: Group Health Inc Medicare |
$727.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.64
|
|
|
SP ENTEROCLYSIS
|
Facility
OP
|
$494.71
|
|
|
Service Code
|
HCPCS 44015 TC
|
| Hospital Charge Code |
41542709
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.15 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$272.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.36
|
| Rate for Payer: Aetna Government |
$247.36
|
| 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 |
$247.36
|
| Rate for Payer: Group Health Inc Medicare |
$173.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.36
|
|
|
SP E.R.C.P. W/STENT
|
Facility
OP
|
$14,479.95
|
|
|
Service Code
|
HCPCS 43274 TC
|
| Hospital Charge Code |
41546008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$7,963.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,963.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,239.98
|
| Rate for Payer: Aetna Government |
$7,239.98
|
| Rate for Payer: Cash Price |
$6,590.73
|
| Rate for Payer: Cash Price |
$6,590.73
|
| 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 |
$7,239.98
|
| Rate for Payer: Group Health Inc Medicare |
$5,067.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,239.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,239.98
|
|
|
SP ESOPHAGUS DILATION
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43453 TC
|
| Hospital Charge Code |
41547677
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,650.94 |
| 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: 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 EVASC PRLNG ADMIN RX AGNT ADD
|
Facility
OP
|
$1,490.25
|
|
|
Service Code
|
HCPCS 61651 TC
|
| Hospital Charge Code |
41543347
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.59 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$819.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$745.12
|
| Rate for Payer: Aetna Government |
$745.12
|
| 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 |
$745.12
|
| Rate for Payer: Group Health Inc Medicare |
$521.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$745.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$745.12
|
|
|
SP EVASC PRLNG ADMN RX AGNT 1ST
|
Facility
OP
|
$3,499.05
|
|
|
Service Code
|
HCPCS 61650 TC
|
| Hospital Charge Code |
41543346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,224.67 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,924.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,749.52
|
| Rate for Payer: Aetna Government |
$1,749.52
|
| 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 |
$1,749.52
|
| Rate for Payer: Group Health Inc Medicare |
$1,224.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,749.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,749.52
|
|
|
SP EXCHANGE PREVIOUS DRAIN CATH
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 49423 TC
|
| Hospital Charge Code |
41561814
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,650.94 |
| 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: 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 EXT. ART. NDL/INTA. BI
|
Facility
OP
|
$1,475.15
|
|
|
Service Code
|
HCPCS 36140 TC
|
| Hospital Charge Code |
41542030
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$516.30 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$811.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$737.58
|
| Rate for Payer: Aetna Government |
$737.58
|
| 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 |
$737.58
|
| Rate for Payer: Group Health Inc Medicare |
$516.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$737.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$737.58
|
|
|
SP EXT. ART. NDL/INTA. UNI
|
Facility
OP
|
$1,475.15
|
|
|
Service Code
|
HCPCS 36140 TC
|
| Hospital Charge Code |
41542028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$516.30 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$811.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$737.58
|
| Rate for Payer: Aetna Government |
$737.58
|
| 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 |
$737.58
|
| Rate for Payer: Group Health Inc Medicare |
$516.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$737.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$737.58
|
|
|
SP EXTREMITY VEIN UNILATERAL
|
Facility
OP
|
$570.55
|
|
|
Service Code
|
HCPCS 36000 TC
|
| Hospital Charge Code |
41547445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$199.69 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$313.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.28
|
| Rate for Payer: Aetna Government |
$285.28
|
| 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 |
$285.28
|
| Rate for Payer: Group Health Inc Medicare |
$199.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.28
|
|
|
SP FALLOPIAN DILATION
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58345 TC
|
| Hospital Charge Code |
41548584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,161.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,161.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,783.06
|
| Rate for Payer: Aetna Government |
$3,783.06
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| 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 |
$3,783.06
|
| Rate for Payer: Group Health Inc Medicare |
$2,648.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,783.06
|
|
|
SP FEM/POPL REVASC W/STENT
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
41101441
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$585.22 |
| 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 CHP/HARP/Medicaid |
$585.22
|
| 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 CHP/FHP/Medicaid |
$650.24
|
| 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 FEM/POPL REVAS W/TLA
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37224
|
| Hospital Charge Code |
41101440
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.40 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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 |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$500.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$556.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
SP FEM-POP TRANSLUMBAR
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37225 TC
|
| Hospital Charge Code |
41542770
|
|
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 |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| 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 FIBROID EMBOLIZATION
|
Facility
OP
|
$30,948.00
|
|
|
Service Code
|
HCPCS 37243 TC
|
| Hospital Charge Code |
41549956
|
|
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 FIBRSHTH STRP SEP VENOUS ACC
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36595 TC
|
| Hospital Charge Code |
41549849
|
|
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 FISTULA OR SINUS TRACT STUDY
|
Facility
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 20501 TC
|
| Hospital Charge Code |
41547626
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,430.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,247.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,043.42
|
| Rate for Payer: Aetna Government |
$2,043.42
|
| 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 |
$2,043.42
|
| Rate for Payer: Group Health Inc Medicare |
$1,430.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,043.42
|
|
|
SP FISTULA/SINUS TRACT
|
Facility
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 20501 TC
|
| Hospital Charge Code |
41542822
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,430.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,247.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,043.42
|
| Rate for Payer: Aetna Government |
$2,043.42
|
| 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 |
$2,043.42
|
| Rate for Payer: Group Health Inc Medicare |
$1,430.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,043.42
|
|
|
SP FNA BX W/CT GDN 1ST LES
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 10009
|
| Hospital Charge Code |
41546544
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.62 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
SP FNA BX W/CT GDN EA ADDL
|
Facility
OP
|
$923.79
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
41546545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.47 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.47
|
| Rate for Payer: Aetna Government |
$70.47
|
| 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: Fidelis CHP/HARP/Medicaid |
$76.86
|
| Rate for Payer: Group Health Inc Commercial |
$461.90
|
| Rate for Payer: Group Health Inc Medicare |
$323.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.40
|
|
|
SP FNA BX W/FLUOR GDN 1ST LES
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 10007
|
| Hospital Charge Code |
41546542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
SP FNA BX W/FLUOR GDN EA ADDL
|
Facility
OP
|
$923.79
|
|
|
Service Code
|
HCPCS 10008
|
| Hospital Charge Code |
41546543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.04
|
| Rate for Payer: Aetna Government |
$52.04
|
| 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 |
$57.36
|
| Rate for Payer: Group Health Inc Commercial |
$461.90
|
| Rate for Payer: Group Health Inc Medicare |
$323.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.73
|
|
|
SP FNA BX W/MR GDN 1ST LES
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 10011
|
| Hospital Charge Code |
41546546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$650.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
SP FNA BX W/MR GDN EA ADDL
|
Facility
OP
|
$923.79
|
|
|
Service Code
|
HCPCS 10012
|
| Hospital Charge Code |
41546547
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$234.84 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$234.84
|
| Rate for Payer: Aetna Government |
$234.84
|
| 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 |
$461.90
|
| Rate for Payer: Group Health Inc Medicare |
$323.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$461.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.90
|
|
|
SP FNA BX W/US GDN 1ST LES
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 10005
|
| Hospital Charge Code |
41546540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.32 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
