|
SP MUSCLE PERCUTANEOUS
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 20206 TC
|
| Hospital Charge Code |
41542801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,455.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Government |
$2,078.62
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$2,078.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,078.62
|
|
|
SP NASAL/OROGASTRIC W/STENT
|
Facility
OP
|
$1,101.23
|
|
|
Service Code
|
HCPCS 43752
|
| Hospital Charge Code |
30104154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.47 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$460.76
|
| Rate for Payer: Aetna Government |
$460.76
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$460.76
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$460.76
|
| 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 |
$460.76
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$460.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.08
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$460.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$460.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$460.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$460.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.61
|
| Rate for Payer: Wellcare Medicare |
$437.72
|
|
|
SP NASAL/OROGASTRIC W/STENT
|
Facility
OP
|
$1,101.23
|
|
|
Service Code
|
HCPCS 43752 TC
|
| Hospital Charge Code |
41549812
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$550.62
|
| Rate for Payer: Aetna Government |
$550.62
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$550.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
SP NEPHROSTOGRAM
|
Facility
OP
|
$1,685.60
|
|
|
Service Code
|
HCPCS 50431 TC
|
| Hospital Charge Code |
41542724
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$589.96 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$927.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$842.80
|
| Rate for Payer: Aetna Government |
$842.80
|
| Rate for Payer: Cash Price |
$789.96
|
| Rate for Payer: Cash Price |
$789.96
|
| 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 |
$842.80
|
| Rate for Payer: Group Health Inc Medicare |
$589.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$842.80
|
|
|
SP NEPHROSTOMY TUBE CHANGE
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 50435 TC
|
| Hospital Charge Code |
41542734
|
|
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
|
|
|
SPNGE GAUZE4X416 PLY CTTON STERI
|
Facility
OP
|
$1.24
|
|
| Hospital Charge Code |
40200627
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.62
|
| Rate for Payer: Aetna Government |
$0.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.62
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
|
|
SP NJX AA&/STRD TFRM EPI C/T 1
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64479
|
| Hospital Charge Code |
41101545
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$1,054.06
|
| Rate for Payer: EmblemHealth Commercial |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| Rate for Payer: Group Health Inc Commercial |
$1,054.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,054.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
SP NJX AA&/STRD TFRM EPI C/T EA
|
Facility
OP
|
$1,229.75
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
41101546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.01
|
| Rate for Payer: Aetna Government |
$72.01
|
| 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 |
$65.20
|
| Rate for Payer: Group Health Inc Commercial |
$614.88
|
| Rate for Payer: Group Health Inc Medicare |
$430.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.45
|
|
|
SP NJX AA&/STRD TFRM EPI L/S 1
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64483
|
| Hospital Charge Code |
41101547
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$1,054.06
|
| Rate for Payer: EmblemHealth Commercial |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| Rate for Payer: Group Health Inc Commercial |
$1,054.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,054.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
SP NJX AA&/STRD TFRM EPI L/S EA
|
Facility
OP
|
$1,229.75
|
|
|
Service Code
|
HCPCS 64484
|
| Hospital Charge Code |
41101548
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.08
|
| Rate for Payer: Aetna Government |
$59.08
|
| 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: Fidelis CHP/HARP/Medicaid |
$54.76
|
| Rate for Payer: Group Health Inc Commercial |
$614.88
|
| Rate for Payer: Group Health Inc Medicare |
$430.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.85
|
|
|
SP NJX INTERLAMINAR CRV/THRC
|
Facility
OP
|
$2,533.95
|
|
|
Service Code
|
HCPCS 62325
|
| Hospital Charge Code |
41101517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.46 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$1,054.06
|
| Rate for Payer: EmblemHealth Commercial |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| Rate for Payer: Group Health Inc Commercial |
$1,054.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,054.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,266.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
SP NJX INTERLAMINAR LMBR/SAC
|
Facility
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 62322
|
| Hospital Charge Code |
41563239
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.61 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$1,054.06
|
| Rate for Payer: EmblemHealth Commercial |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| Rate for Payer: Group Health Inc Commercial |
$1,054.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,054.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
SP NJX INTERLAMINAR LMB/SAC
|
Facility
OP
|
$2,533.95
|
|
|
Service Code
|
HCPCS 62327
|
| Hospital Charge Code |
41101539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.64 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$1,054.06
|
| Rate for Payer: EmblemHealth Commercial |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| Rate for Payer: Group Health Inc Commercial |
$1,054.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,054.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,266.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
SP NJX INTRLAMINR LMBR/SAC W/GUID
|
Facility
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
41563240
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.38 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: EmblemHealth Commercial |
$799.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| Rate for Payer: Group Health Inc Commercial |
$799.72
|
| Rate for Payer: Group Health Inc Medicare |
$799.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
SP NJX NONCMPND SCLRSNT 1 VEIN
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 36465 TC
|
| Hospital Charge Code |
41563233
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,720.21 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,703.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,457.44
|
| Rate for Payer: Aetna Government |
$2,457.44
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| 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 |
$2,457.44
|
| Rate for Payer: Group Health Inc Medicare |
$1,720.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,457.44
|
|
|
SP NJX NONCMPND SCLRSNT MLT VN
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 36466 TC
|
| Hospital Charge Code |
41563234
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,720.21 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,703.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,457.44
|
| Rate for Payer: Aetna Government |
$2,457.44
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| 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 |
$2,457.44
|
| Rate for Payer: Group Health Inc Medicare |
$1,720.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,457.44
|
|
|
SP NJX SCLRSNT 1 INCMPTNT VEIN
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 36470 TC
|
| Hospital Charge Code |
41563231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.71 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$532.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$483.86
|
| Rate for Payer: Aetna Government |
$483.86
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| 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 |
$483.86
|
| Rate for Payer: Group Health Inc Medicare |
$338.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.86
|
|
|
SP NJX SCLRSNT MLT INCMPTNT VN
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 36471 TC
|
| Hospital Charge Code |
41563232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.71 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$532.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$483.86
|
| Rate for Payer: Aetna Government |
$483.86
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| 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 |
$483.86
|
| Rate for Payer: Group Health Inc Medicare |
$338.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.86
|
|
|
SP NJX SCLRSNT SPIDER VEINS
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 36468 TC
|
| Hospital Charge Code |
41563230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.23 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$264.62
|
| Rate for Payer: Aetna Government |
$264.62
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| 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 |
$264.62
|
| Rate for Payer: Group Health Inc Medicare |
$185.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.62
|
|
|
SP NON-RF LIVER ABLATION
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 47399 TC
|
| Hospital Charge Code |
41561825
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$646.65 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,016.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$923.79
|
| Rate for Payer: Aetna Government |
$923.79
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$923.79
|
| Rate for Payer: Group Health Inc Medicare |
$646.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$923.79
|
|
|
SP NON SELECTIVE SPLENOPORTOGRAPH
|
Facility
OP
|
$379.68
|
|
|
Service Code
|
HCPCS 38200 TC
|
| Hospital Charge Code |
41547708
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.89 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$208.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.84
|
| Rate for Payer: Aetna Government |
$189.84
|
| 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 |
$189.84
|
| Rate for Payer: Group Health Inc Medicare |
$132.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.84
|
|
|
SPONGE, CMPR 8X8X10MM
|
Facility
OP
|
$2,252.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,364.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,238.62
|
| 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 |
$1,126.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,294.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,364.63
|
| Rate for Payer: Group Health Inc Commercial |
$1,126.02
|
| Rate for Payer: Group Health Inc Medicare |
$788.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,126.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,126.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,463.82
|
|
|
SPONGE, CMPR 8X8X10MM
|
Facility
IP
|
$2,252.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905397
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.02 |
| Max. Negotiated Rate |
$1,126.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,126.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,126.02
|
|
|
SPONGE CMPR LG 16X5X23MM
|
Facility
IP
|
$4,413.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.99 |
| Max. Negotiated Rate |
$2,206.99 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,206.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,206.99
|
|
|
SPONGE CMPR LG 16X5X23MM
|
Facility
OP
|
$4,413.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,634.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,427.69
|
| 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 |
$2,206.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,538.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,634.68
|
| Rate for Payer: Group Health Inc Commercial |
$2,206.99
|
| Rate for Payer: Group Health Inc Medicare |
$1,544.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,206.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,206.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,869.09
|
|
