|
SP REM IMPLANT VEN CATH
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36589 TC
|
| Hospital Charge Code |
41542833
|
|
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 |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| 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: 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 REM IMPL INTRAVENOUS INFU PUMP
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36590 TC
|
| Hospital Charge Code |
41547712
|
|
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 REM NEPHROSTOMY W/FLUORO
|
Facility
OP
|
$1,685.60
|
|
|
Service Code
|
HCPCS 50389 TC
|
| Hospital Charge Code |
41548033
|
|
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 REMOVAL G-, J-, G-J, C TUBE ON
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49460 TC
|
| Hospital Charge Code |
41561932
|
|
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 REMOVAL OF TUN INTRAPERITONEAL
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 49422 TC
|
| Hospital Charge Code |
41561816
|
|
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 REMOVE DUCT GLBLDR CALCULI
|
Facility
OP
|
$1,562.73
|
|
|
Service Code
|
HCPCS 47544 TC
|
| Hospital Charge Code |
41542714
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$546.96 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$859.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$781.36
|
| Rate for Payer: Aetna Government |
$781.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$781.36
|
| Rate for Payer: Group Health Inc Medicare |
$546.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$781.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$781.36
|
|
|
SP REMOVE FOREIGN BODY ABDOMEN
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 49402 TC
|
| Hospital Charge Code |
41561817
|
|
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 REMOVE LUNG CATHETER
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32552 TC
|
| Hospital Charge Code |
41561813
|
|
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 |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| 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: 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 REM&REP DOUBLEJ_PERC
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 50382 TC
|
| Hospital Charge Code |
41548030
|
|
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 RENAL BIOPSY
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 50200 TC
|
| Hospital Charge Code |
41542302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| 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: EmblemHealth Commercial |
$745.00
|
| 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 RENAL TRANSLUMBAR
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
41542762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$15,005.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$12,721.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| Rate for Payer: Group Health Inc Commercial |
$12,721.98
|
| Rate for Payer: Group Health Inc Medicare |
$12,721.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
|
|
SP REPAIR ANE,FALS ANE &OCCLDISAB
|
Facility
OP
|
$5,313.27
|
|
|
Service Code
|
HCPCS 35081 TC
|
| Hospital Charge Code |
41547704
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,859.64 |
| Max. Negotiated Rate |
$2,922.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,922.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,656.64
|
| Rate for Payer: Aetna Government |
$2,656.64
|
| 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 |
$2,656.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,859.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,656.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,656.64
|
|
|
SP REP DISL G-J TUBE COMPLEX
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 44373 TC
|
| Hospital Charge Code |
41547667
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| 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: EmblemHealth Commercial |
$745.00
|
| 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 REP DISL G-J TUBE COMPLEX
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 43761 TC
|
| Hospital Charge Code |
41547665
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$391.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$355.72
|
| Rate for Payer: Aetna Government |
$355.72
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| 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 |
$355.72
|
| Rate for Payer: Group Health Inc Medicare |
$249.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.72
|
|
|
SP REPLACE AREM-CHEST PORT
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36578 TC
|
| Hospital Charge Code |
41561831
|
|
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 REPLACE ARM PORT ENTIRE
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36585 TC
|
| Hospital Charge Code |
41561833
|
|
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 REPLACE CHEST PORT ENTIRE
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36582 TC
|
| Hospital Charge Code |
41561834
|
|
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 REPLACE DUOD/JEJ TUBE PERC
|
Facility
OP
|
$2,316.08
|
|
|
Service Code
|
HCPCS 49451 TC
|
| Hospital Charge Code |
41561821
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$810.63 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,273.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,158.04
|
| Rate for Payer: Aetna Government |
$1,158.04
|
| 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 |
$1,158.04
|
| Rate for Payer: Group Health Inc Medicare |
$810.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,158.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,158.04
|
|
|
SPREPLACE G/C TUBE PERC
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49450 TC
|
| Hospital Charge Code |
41561823
|
|
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 REPLACE G-J TUBE PERC
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49452 TC
|
| Hospital Charge Code |
41561822
|
|
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 REPL DISLODG G-J TUBE SIMPLE
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 43763 TC
|
| Hospital Charge Code |
41547661
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$391.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$355.72
|
| Rate for Payer: Aetna Government |
$355.72
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| 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 |
$355.72
|
| Rate for Payer: Group Health Inc Medicare |
$249.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.72
|
|
|
SP REPN CENTVENCAT
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36597 TC
|
| Hospital Charge Code |
41549850
|
|
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 REPO. CENTRAL VEN. CATH
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36597 TC
|
| Hospital Charge Code |
41542836
|
|
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 REPOSI DISLODG G-J TUBE SIMPLE
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 43761 TC
|
| Hospital Charge Code |
41547663
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$391.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$355.72
|
| Rate for Payer: Aetna Government |
$355.72
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| 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 |
$355.72
|
| Rate for Payer: Group Health Inc Medicare |
$249.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.72
|
|
|
SP REPOSITION GI FEED TBE
|
Facility
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 43761 TC
|
| Hospital Charge Code |
41542710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$391.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$355.72
|
| Rate for Payer: Aetna Government |
$355.72
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| 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 |
$355.72
|
| Rate for Payer: Group Health Inc Medicare |
$249.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$355.72
|
|
