|
SPONGE PEANUT B
|
Facility
OP
|
$0.43
|
|
| Hospital Charge Code |
64901801
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
|
|
SPONGE TONSIL MEDIUM 30-037
|
Facility
OP
|
$0.22
|
|
| Hospital Charge Code |
40200629
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
|
|
SPONGE TONSIL MEDIUM SING-STRUNG
|
Facility
OP
|
$1.04
|
|
| Hospital Charge Code |
64902901
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.52
|
| Rate for Payer: Aetna Government |
$0.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.52
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.52
|
|
|
SPONGE XRAY DETECT.4X4 16PLY
|
Facility
OP
|
$1.25
|
|
| Hospital Charge Code |
64901143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.85
|
| Rate for Payer: Group Health Inc Commercial |
$0.63
|
| Rate for Payer: Group Health Inc Medicare |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.63
|
|
|
SP OVARIAN ABSCESS ABD (PERCUTA)
|
Facility
OP
|
$1,894.38
|
|
|
Service Code
|
HCPCS 58822 TC
|
| Hospital Charge Code |
41547625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$663.03 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,041.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$947.19
|
| Rate for Payer: Aetna Government |
$947.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$947.19
|
| Rate for Payer: Group Health Inc Medicare |
$663.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$947.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$947.19
|
|
|
SP OVARIAN CYST ABDOMINAL
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58805
|
| Hospital Charge Code |
41507623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$482.06 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$482.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$535.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
SP OVARIAN CYST ABDOMINAL
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58805 TC
|
| Hospital Charge Code |
41547623
|
|
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 OVARIAN CYST TRANSVAGINAL
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58800 TC
|
| Hospital Charge Code |
41547622
|
|
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 PANCREAS PERCUTANEOUS
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 48102 TC
|
| Hospital Charge Code |
41542802
|
|
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 PANCREAS PSEUDOCYST DRNGE PERC
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 49405 TC
|
| Hospital Charge Code |
41549575
|
|
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 PARACENTESIS,INITIAL
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49083 TC
|
| Hospital Charge Code |
41547611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$833.12 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,309.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,190.18
|
| Rate for Payer: Aetna Government |
$1,190.18
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| 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 |
$1,190.18
|
| Rate for Payer: Group Health Inc Medicare |
$833.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,190.18
|
|
|
SP PASS/HICKMAN/ PER. CATH
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 36557
|
| Hospital Charge Code |
30102475
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$6,354.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$6,354.94
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$369.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6,354.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
SP PASS/HICKMAN/ PER. CATH
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36557 TC
|
| Hospital Charge Code |
41542806
|
|
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 PELVIC ABSCESS TRANSVAGINAL
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 49407 TC
|
| Hospital Charge Code |
41547624
|
|
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 PERC BIL DRAIN (EXTER)
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47533 TC
|
| Hospital Charge Code |
41542720
|
|
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 PERC BIL DRAIN (INT/EXT)
|
Facility
OP
|
$1,714.43
|
|
| Hospital Charge Code |
41542722
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.05 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$942.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$857.22
|
| Rate for Payer: Aetna Government |
$857.22
|
| 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 |
$857.22
|
| Rate for Payer: Group Health Inc Medicare |
$600.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$857.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$857.22
|
|
|
SP PERC. CHOLECYSTOTOMY
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47490 TC
|
| Hospital Charge Code |
41547451
|
|
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 PERC DILA BIL STRICT W/O STENT
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47555 TC
|
| Hospital Charge Code |
41547669
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| 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: EmblemHealth Commercial |
$745.00
|
| 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 PERC DILA BIL STRICT W STENT
|
Facility
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47556 TC
|
| Hospital Charge Code |
41547671
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$8,052.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,052.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,320.05
|
| Rate for Payer: Aetna Government |
$7,320.05
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Group Health Inc Commercial |
$7,320.05
|
| Rate for Payer: Group Health Inc Medicare |
$5,124.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,320.05
|
|
|
SP PERC DIL BIL W/O STENT
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47555 TC
|
| Hospital Charge Code |
41542716
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| 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: EmblemHealth Commercial |
$745.00
|
| 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 PERC DIL BIL W/ STENT
|
Facility
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47556 TC
|
| Hospital Charge Code |
41542718
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$8,052.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,052.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,320.05
|
| Rate for Payer: Aetna Government |
$7,320.05
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Group Health Inc Commercial |
$7,320.05
|
| Rate for Payer: Group Health Inc Medicare |
$5,124.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,320.05
|
|
|
SP PERC OCCLUSION FEMORAL VEIN
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37650 TC
|
| Hospital Charge Code |
41547691
|
|
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 PERC OCCLUSION ILLIAC VEIN
|
Facility
OP
|
$3,327.13
|
|
|
Service Code
|
HCPCS 37660 TC
|
| Hospital Charge Code |
41547692
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,164.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,829.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,663.56
|
| Rate for Payer: Aetna Government |
$1,663.56
|
| 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 |
$1,663.56
|
| Rate for Payer: Group Health Inc Medicare |
$1,164.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,663.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,663.56
|
|
|
SP PERC PLACE DUOD/JEJ TUBE
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 49441 TC
|
| Hospital Charge Code |
41561820
|
|
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 PERC PLACE IVC FILTER
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37191 TC
|
| Hospital Charge Code |
41542778
|
|
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
|
|
