|
SPINE HEALOSLL BON GRFT STRPS16ML
|
Facility
OP
|
$5,040.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40009114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$5,292.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,772.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,520.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,898.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,292.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,520.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,764.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,520.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,520.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,276.00
|
|
|
SPINE IMPLANT CERV 17MM H
|
Facility
IP
|
$10,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,475.00 |
| Max. Negotiated Rate |
$5,475.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,475.00
|
|
|
SPINE IMPLANT CERV 17MM H
|
Facility
OP
|
$10,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64905047
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$11,497.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,022.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,475.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,296.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,497.50
|
| Rate for Payer: Group Health Inc Commercial |
$5,475.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,832.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,475.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,475.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,117.50
|
|
|
SP INFUSION OF CATH FIBRIN SHEATH
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 36593 TC
|
| Hospital Charge Code |
41561835
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.20 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$468.85
|
| Rate for Payer: Aetna Government |
$468.85
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| 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 |
$468.85
|
| Rate for Payer: Group Health Inc Medicare |
$328.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$468.85
|
|
|
SP INJ CHOLANGIO EXT CATH
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47531 TC
|
| Hospital Charge Code |
41548038
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$5,179.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,179.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,708.72
|
| Rate for Payer: Aetna Government |
$4,708.72
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| 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 |
$4,708.72
|
| Rate for Payer: Group Health Inc Medicare |
$3,296.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,708.72
|
|
|
SP INJ CON OR AIR INTO PERIT CAVI
|
Facility
OP
|
$505.78
|
|
|
Service Code
|
HCPCS 49400 TC
|
| Hospital Charge Code |
41547617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.02 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$278.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$252.89
|
| Rate for Payer: Aetna Government |
$252.89
|
| 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 |
$252.89
|
| Rate for Payer: Group Health Inc Medicare |
$177.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.89
|
|
|
SP INJ PROC EVAL PERTIO VEN SHUNT
|
Facility
OP
|
$2,425.06
|
|
|
Service Code
|
HCPCS 49427 TC
|
| Hospital Charge Code |
41547620
|
|
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
|
|
|
SPINL TRAY SPINL TAP LUMBR PU
|
Facility
OP
|
$45.36
|
|
| Hospital Charge Code |
40205730
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$36.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.68
|
| Rate for Payer: Aetna Government |
$22.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.84
|
| Rate for Payer: Group Health Inc Commercial |
$22.68
|
| Rate for Payer: Group Health Inc Medicare |
$15.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.68
|
|
|
SP INS CENT LN NONTUN < 5
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36555 TC
|
| Hospital Charge Code |
41549853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,729.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,470.14
|
| Rate for Payer: Aetna Government |
$2,470.14
|
| 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 |
$2,470.14
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.14
|
|
|
SP INS CENT LN NONTUN > 5
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36556 TC
|
| Hospital Charge Code |
41549854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,729.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,470.14
|
| Rate for Payer: Aetna Government |
$2,470.14
|
| 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 |
$2,470.14
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.14
|
|
|
SP INSERTION MIDLINE CATHETER
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
41542902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.30 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,852.05
|
| Rate for Payer: Aetna Government |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,852.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,852.05
|
| Rate for Payer: EmblemHealth Commercial |
$1,852.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,574.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,648.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,852.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,648.32
|
| Rate for Payer: Group Health Inc Commercial |
$1,852.05
|
| Rate for Payer: Group Health Inc Medicare |
$1,852.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,574.24
|
| Rate for Payer: Healthfirst QHP |
$1,852.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,481.64
|
| Rate for Payer: Wellcare Medicare |
$1,759.45
|
|
|
SP INSERT OF TUN CATH DIALYSIS
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 49421 TC
|
| Hospital Charge Code |
41561815
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$5,179.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,179.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,708.72
|
| Rate for Payer: Aetna Government |
$4,708.72
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| 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 |
$4,708.72
|
| Rate for Payer: Group Health Inc Medicare |
$3,296.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,708.72
|
|
|
SP INSERT PERITONEAL VENOUS SHUNT
|
Facility
OP
|
$2,425.06
|
|
|
Service Code
|
HCPCS 49425 TC
|
| Hospital Charge Code |
41561819
|
|
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 INSERT PLEURAL CATH
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 32550 TC
|
| Hospital Charge Code |
41561818
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$5,179.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,179.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,708.72
|
| Rate for Payer: Aetna Government |
$4,708.72
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| 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 |
$4,708.72
|
| Rate for Payer: Group Health Inc Medicare |
$3,296.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,708.72
|
|
|
SP INSERT SUPRAPUBIC CATHETER
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 51102 TC
|
| Hospital Charge Code |
41547644
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,877.95 |
| Max. Negotiated Rate |
$2,951.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,951.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,682.79
|
| Rate for Payer: Aetna Government |
$2,682.79
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| 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 |
$2,682.79
|
| Rate for Payer: Group Health Inc Medicare |
$1,877.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,682.79
|
|
|
SP INSERT TUN IP CATH PERCU
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 49418 TC
|
| Hospital Charge Code |
41561908
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$5,179.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,179.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,708.72
|
| Rate for Payer: Aetna Government |
$4,708.72
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| 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 |
$4,708.72
|
| Rate for Payer: Group Health Inc Medicare |
$3,296.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,708.72
|
|
|
SP INS GRAFT,AORTA OR GRT VESW/OS
|
Facility
OP
|
$4,544.47
|
|
|
Service Code
|
HCPCS 33330 TC
|
| Hospital Charge Code |
41547695
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,590.56 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,499.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,272.24
|
| Rate for Payer: Aetna Government |
$2,272.24
|
| 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 |
$2,272.24
|
| Rate for Payer: Group Health Inc Medicare |
$1,590.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,272.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,272.24
|
|
|
SP INTERCOSTAL BLOCK
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64421 TC
|
| Hospital Charge Code |
41561841
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$860.82 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,352.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,229.75
|
| Rate for Payer: Aetna Government |
$1,229.75
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| 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 |
$1,229.75
|
| Rate for Payer: Group Health Inc Medicare |
$860.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,229.75
|
|
|
SP INTERNAL MAMMARY ANGIO
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75756 TC
|
| Hospital Charge Code |
41561889
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.99 |
| Max. Negotiated Rate |
$6,714.82 |
| 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 |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.99
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.32
|
|
|
SP INTRA ARTERIAL CHEMO,INFUSION
|
Facility
OP
|
$556.18
|
|
|
Service Code
|
HCPCS 96422 TC
|
| Hospital Charge Code |
41561852
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$194.66 |
| Max. Negotiated Rate |
$644.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$278.09
|
| Rate for Payer: Aetna Government |
$278.09
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$278.09
|
| Rate for Payer: Group Health Inc Medicare |
$194.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$278.09
|
|
|
SP INTRACRAN ANGIOPLSTY W/STENT
|
Facility
OP
|
$9,552.85
|
|
|
Service Code
|
HCPCS 61635 TC
|
| Hospital Charge Code |
41543349
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$5,254.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,254.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,776.42
|
| Rate for Payer: Aetna Government |
$4,776.42
|
| 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 |
$4,776.42
|
| Rate for Payer: Group Health Inc Medicare |
$3,343.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,776.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,776.42
|
|
|
SP INTRACRANIAL ANGIOPLASTY
|
Facility
OP
|
$9,062.15
|
|
|
Service Code
|
HCPCS 61630 TC
|
| Hospital Charge Code |
41543348
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,984.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,984.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,531.08
|
| Rate for Payer: Aetna Government |
$4,531.08
|
| 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 |
$4,531.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,171.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,531.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,531.08
|
|
|
SP INTR INTRAVAS STNT 1ST
|
Facility
OP
|
$30,948.00
|
|
|
Service Code
|
HCPCS 37236 TC
|
| Hospital Charge Code |
41104045
|
|
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 INTR INTRAVAS STNT ADD
|
Facility
OP
|
$15,474.00
|
|
|
Service Code
|
HCPCS 37237 TC
|
| Hospital Charge Code |
41104047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$8,510.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,510.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,737.00
|
| Rate for Payer: Aetna Government |
$7,737.00
|
| 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 |
$7,737.00
|
| Rate for Payer: Group Health Inc Medicare |
$5,415.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,737.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,737.00
|
|
|
SP INVUS NONCORONARY ADD VESSEL
|
Facility
OP
|
$1,520.83
|
|
|
Service Code
|
HCPCS 37253 TC
|
| Hospital Charge Code |
41561848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$836.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$760.42
|
| Rate for Payer: Aetna Government |
$760.42
|
| 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 |
$760.42
|
| Rate for Payer: Group Health Inc Medicare |
$532.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$760.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$760.42
|
|
