|
SP STENT PLACEMENT
|
Facility
OP
|
$30,948.00
|
|
|
Service Code
|
HCPCS 37236 TC
|
| Hospital Charge Code |
41547728
|
|
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 STENT PLACEMENT ADD
|
Facility
OP
|
$13,095.00
|
|
|
Service Code
|
HCPCS 37239 TC
|
| Hospital Charge Code |
41104011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$7,202.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,202.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,547.50
|
| Rate for Payer: Aetna Government |
$6,547.50
|
| 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 |
$6,547.50
|
| Rate for Payer: Group Health Inc Medicare |
$4,583.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,547.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,547.50
|
|
|
SP STENT PLACEMT ANTE CAROTID
|
Facility
OP
|
$6,859.25
|
|
|
Service Code
|
HCPCS 37218 TC
|
| Hospital Charge Code |
41562375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,400.74 |
| Max. Negotiated Rate |
$3,772.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,772.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,429.62
|
| Rate for Payer: Aetna Government |
$3,429.62
|
| 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 |
$3,429.62
|
| Rate for Payer: Group Health Inc Medicare |
$2,400.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,429.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,429.62
|
|
|
SP STENT PLACEMT RETRO CAROTID
|
Facility
OP
|
$9,114.44
|
|
|
Service Code
|
HCPCS 37217 TC
|
| Hospital Charge Code |
41562373
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$5,012.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,012.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,557.22
|
| Rate for Payer: Aetna Government |
$4,557.22
|
| 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 |
$4,557.22
|
| Rate for Payer: Group Health Inc Medicare |
$3,190.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,557.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,557.22
|
|
|
SP STEREO EACH ADD
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 19284 TC
|
| Hospital Charge Code |
41104041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.00
|
| Rate for Payer: Aetna Government |
$73.00
|
| 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 |
$73.00
|
| Rate for Payer: Group Health Inc Medicare |
$51.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.00
|
|
|
SP STEREO GUIDED 1ST LOCAL
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 19283 TC
|
| Hospital Charge Code |
41104039
|
|
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 STEROTACTIC TX ADD
|
Facility
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 19082
|
| Hospital Charge Code |
41104017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.75
|
| Rate for Payer: Aetna Government |
$72.75
|
| 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 |
$87.98
|
| Rate for Payer: Group Health Inc Commercial |
$521.00
|
| Rate for Payer: Group Health Inc Medicare |
$364.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$521.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.76
|
|
|
SP STROTACTIC BX
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 19081
|
| Hospital Charge Code |
41104015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,874.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
SP SUP/INF VENA CAVA
|
Facility
OP
|
$1,769.28
|
|
|
Service Code
|
HCPCS 36010 TC
|
| Hospital Charge Code |
41542034
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$619.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$973.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$884.64
|
| Rate for Payer: Aetna Government |
$884.64
|
| 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 |
$884.64
|
| Rate for Payer: Group Health Inc Medicare |
$619.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$884.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$884.64
|
|
|
SP SWAN GANZ CATHETER INSERTION
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 93503 TC
|
| Hospital Charge Code |
41561840
|
|
Hospital Revenue Code
|
489
|
| Min. Negotiated Rate |
$1,729.10 |
| Max. Negotiated Rate |
$3,952.22 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$3,952.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,359.39
|
| 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 TANKOFF CATH. REPOSITION
|
Facility
OP
|
$2,425.06
|
|
|
Service Code
|
HCPCS 49427 TC
|
| Hospital Charge Code |
41547463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$848.77 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,333.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,212.53
|
| Rate for Payer: Aetna Government |
$1,212.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$1,212.53
|
| Rate for Payer: Group Health Inc Medicare |
$848.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,212.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,212.53
|
|
|
SP TAP BLOCK BI BY INFUSION
|
Facility
OP
|
$1,529.68
|
|
|
Service Code
|
HCPCS 64489
|
| Hospital Charge Code |
41303223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.58
|
| Rate for Payer: Aetna Government |
$102.58
|
| 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 |
$82.50
|
| Rate for Payer: Group Health Inc Commercial |
$764.84
|
| Rate for Payer: Group Health Inc Medicare |
$535.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.67
|
|
|
SP TAP BLOCK BI INJECTION
|
Facility
OP
|
$1,529.68
|
|
|
Service Code
|
HCPCS 64488
|
| Hospital Charge Code |
41303222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$175.93
|
| Rate for Payer: Aetna Government |
$175.93
|
| 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 |
$71.06
|
| Rate for Payer: Group Health Inc Commercial |
$764.84
|
| Rate for Payer: Group Health Inc Medicare |
$535.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.96
|
|
|
SP TAP BLOCK UNI BY INFUSION
|
Facility
OP
|
$1,529.68
|
|
|
Service Code
|
HCPCS 64487
|
| Hospital Charge Code |
41303221
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.09 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.41
|
| Rate for Payer: Aetna Government |
$84.41
|
| 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 |
$66.09
|
| Rate for Payer: Group Health Inc Commercial |
$764.84
|
| Rate for Payer: Group Health Inc Medicare |
$535.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.43
|
|
|
SP TAP BLOCK UNIL BY INJECTION
|
Facility
OP
|
$1,529.68
|
|
|
Service Code
|
HCPCS 64486
|
| Hospital Charge Code |
41303220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$71.93
|
| Rate for Payer: Aetna Government |
$71.93
|
| 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 |
$57.88
|
| Rate for Payer: Group Health Inc Commercial |
$764.84
|
| Rate for Payer: Group Health Inc Medicare |
$535.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.31
|
|
|
SP TCD COMPLETE
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93886 TC
|
| Hospital Charge Code |
41201162
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$247.04 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.85
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$278.72
|
|
|
SP TCD LIMITED
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93888 TC
|
| Hospital Charge Code |
41201163
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.63
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.26
|
|
|
SP THORACENTESIS TUBE/THOR
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555 TC
|
| Hospital Charge Code |
41542791
|
|
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 THRMBLYTC DECLOT VAS ACCESS
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 36593 TC
|
| Hospital Charge Code |
41548022
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.20 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$468.85
|
| Rate for Payer: Aetna Government |
$468.85
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$468.85
|
| Rate for Payer: Group Health Inc Medicare |
$328.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$468.85
|
|
|
SP THRMBN INJ PSEUDOANEURYSM
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36002 TC
|
| Hospital Charge Code |
41548023
|
|
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 THROMB ART/VEN THERAPY SUBSEQ
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 37213 TC
|
| Hospital Charge Code |
41543302
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$1,729.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,470.14
|
| Rate for Payer: Aetna Government |
$2,470.14
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.14
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.14
|
|
|
SP THROMBECTOMY GRAFT
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 35875 TC
|
| Hospital Charge Code |
41547703
|
|
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 THROMBO DECLOTTNG VASC ACCESS
|
Facility
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 36593 TC
|
| Hospital Charge Code |
41549872
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.20 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$468.85
|
| Rate for Payer: Aetna Government |
$468.85
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$468.85
|
| Rate for Payer: Group Health Inc Medicare |
$328.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$468.85
|
|
|
SP THROMB OF ART/VEN GRAFT-PERC
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 35876 TC
|
| Hospital Charge Code |
41547719
|
|
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 THROMBOLYTIC ARTERIAL THERAPY
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37211 TC
|
| Hospital Charge Code |
41543300
|
|
Hospital Revenue Code
|
329
|
| 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
|
|
