|
SP PERC. RENAL CYST ASPIR.
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 50390 TC
|
| Hospital Charge Code |
41547459
|
|
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 PERC TRANSCATH RETR.
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37197 TC
|
| Hospital Charge Code |
41542747
|
|
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 TRANSHEPATIC CHOLANGIOGR
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47532 TC
|
| Hospital Charge Code |
41547682
|
|
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 PERCUTANEOUS SYMPATHECTOMY
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64680 TC
|
| Hospital Charge Code |
41561843
|
|
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 PERICARDIOCENTESIS W/IMAGING
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 33016 TC
|
| Hospital Charge Code |
41546550
|
|
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 |
$1,852.05
|
| Rate for Payer: Cash Price |
$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: 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 PERITO DIALYSIS CATH MANIPULAT
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37197 TC
|
| Hospital Charge Code |
41547613
|
|
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 PERITONEAL CATH. PLACE.
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 49406 TC
|
| Hospital Charge Code |
41546004
|
|
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 PERITONEO/PARACENTESIS SUBSEQ
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49084 TC
|
| Hospital Charge Code |
41542789
|
|
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 PERQ ART M-THROMBECT &/NFS
|
Facility
OP
|
$5,361.05
|
|
|
Service Code
|
HCPCS 61645 TC
|
| Hospital Charge Code |
41543345
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,876.37 |
| Max. Negotiated Rate |
$2,948.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,948.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,680.52
|
| Rate for Payer: Aetna Government |
$2,680.52
|
| 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 |
$2,680.52
|
| Rate for Payer: Group Health Inc Medicare |
$1,876.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,680.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,680.52
|
|
|
SP PERQ CIVICOTHORACIC INJ
|
Facility
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 22510 TC
|
| Hospital Charge Code |
41543550
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,560.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,560.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,145.52
|
| Rate for Payer: Aetna Government |
$4,145.52
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| 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 |
$4,145.52
|
| Rate for Payer: Group Health Inc Medicare |
$2,901.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,145.52
|
|
|
SP PERQ PRCRD DRG INSJ CATH CT
|
Facility
OP
|
$901.95
|
|
|
Service Code
|
HCPCS 33019 TC
|
| Hospital Charge Code |
41546553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.68 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$496.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$450.98
|
| Rate for Payer: Aetna Government |
$450.98
|
| 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 |
$450.98
|
| Rate for Payer: Group Health Inc Medicare |
$315.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.98
|
|
|
SP PHYSICIAN TIME REQ TO START IV
|
Facility
OP
|
$28.86
|
|
|
Service Code
|
HCPCS 36410 TC
|
| Hospital Charge Code |
41547714
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.43
|
| Rate for Payer: Aetna Government |
$14.43
|
| 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 |
$14.43
|
| Rate for Payer: Group Health Inc Medicare |
$10.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.43
|
|
|
SP PICC EXCH
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36584 TC
|
| Hospital Charge Code |
41549846
|
|
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 |
$1,852.05
|
| Rate for Payer: Cash Price |
$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: 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 PICC INS < 5 YRS OLD
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36569
|
| Hospital Charge Code |
41549841
|
|
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 PICC INS > 5 YRS OLD
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36568 TC
|
| Hospital Charge Code |
41549840
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$668.38 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,050.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$954.82
|
| Rate for Payer: Aetna Government |
$954.82
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$954.82
|
| Rate for Payer: Group Health Inc Medicare |
$668.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$954.82
|
|
|
SP PLACE CATH CAROTID ARTERY
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36224 TC
|
| Hospital Charge Code |
41103003
|
|
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 PLACE CATH INOM ART W CCA
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36222 TC
|
| Hospital Charge Code |
41102999
|
|
Hospital Revenue Code
|
329
|
| 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 PLACE CATH SUBCLAVIAN ART
|
Facility
OP
|
$8,818.00
|
|
|
Service Code
|
HCPCS 36225 TC
|
| Hospital Charge Code |
41103005
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,849.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,849.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,409.00
|
| Rate for Payer: Aetna Government |
$4,409.00
|
| 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 |
$4,409.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,086.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,409.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,409.00
|
|
|
SP PLACE CATH THORACIC AORTA
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36221 TC
|
| Hospital Charge Code |
41103000
|
|
Hospital Revenue Code
|
329
|
| 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 PLACE CATH VERTEBRAL ART
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36226 TC
|
| Hospital Charge Code |
41103007
|
|
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 PLACE GASTROSTOMY TUBE PERC
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 49440 TC
|
| Hospital Charge Code |
41542706
|
|
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 PLACE GASTROSTOMY TUBE PERC
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 49440 TC
|
| Hospital Charge Code |
41547657
|
|
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 PLACE INTRAVAS STENT 1ST
|
Facility
OP
|
$30,948.00
|
|
|
Service Code
|
HCPCS 37236 TC
|
| Hospital Charge Code |
41542758
|
|
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 PLACE INTRAVAS STENT ADD
|
Facility
OP
|
$15,474.00
|
|
|
Service Code
|
HCPCS 37237 TC
|
| Hospital Charge Code |
41542760
|
|
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 PLACEMENT URETERAL STENT EXIST
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
41542910
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.05 |
| Max. Negotiated Rate |
$4,571.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| 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: Elderplan Medicare Advantage |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$4,031.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
