|
SP URETHROCYSTOGRAM, RETRO
|
Facility
OP
|
$855.81
|
|
|
Service Code
|
HCPCS 51610 TC
|
| Hospital Charge Code |
41542828
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$299.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$427.90
|
| Rate for Payer: Aetna Government |
$427.90
|
| 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 |
$427.90
|
| Rate for Payer: Group Health Inc Medicare |
$299.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.90
|
|
|
SP URETHROCYSTOGRAM VOID
|
Facility
OP
|
$605.55
|
|
|
Service Code
|
HCPCS 51600 TC
|
| Hospital Charge Code |
41542526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.94 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$333.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302.78
|
| Rate for Payer: Aetna Government |
$302.78
|
| 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 |
$302.78
|
| Rate for Payer: Group Health Inc Medicare |
$211.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302.78
|
|
|
SP US GUIDED 1ST LOCAL
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 19285 TC
|
| Hospital Charge Code |
41104043
|
|
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 US GUIDED BREAST ADD
|
Facility
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 19084
|
| Hospital Charge Code |
41104021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$68.16
|
| Rate for Payer: Aetna Government |
$68.16
|
| 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 |
$82.95
|
| 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 |
$92.17
|
|
|
SP US GUIDED BREAST BX
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 19083
|
| Hospital Charge Code |
41104019
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$163.05 |
| 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 |
$163.05
|
| 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 |
$181.17
|
| 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 US GUIDED EACH ADD
|
Facility
OP
|
$1,042.00
|
|
|
Service Code
|
HCPCS 19286 TC
|
| Hospital Charge Code |
41104025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.70 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$573.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$521.00
|
| Rate for Payer: Aetna Government |
$521.00
|
| 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 |
$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
|
|
|
SPUTUM COLLECTION/INDUCTION
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306700
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
SP VASC ABLAT 1ST VEIN
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36478 TC
|
| Hospital Charge Code |
41563283
|
|
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 VASC ABLAT EACH ADD'L VEIN
|
Facility
OP
|
$2,077.28
|
|
|
Service Code
|
HCPCS 36476 TC
|
| Hospital Charge Code |
41563284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$727.05 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,142.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,038.64
|
| Rate for Payer: Aetna Government |
$1,038.64
|
| 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 |
$1,038.64
|
| Rate for Payer: Group Health Inc Medicare |
$727.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.64
|
|
|
SP VASCU EMBO ARTERY
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37242 TC
|
| Hospital Charge Code |
41104005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$16,505.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,505.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,005.15
|
| Rate for Payer: Aetna Government |
$15,005.15
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| 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 |
$15,005.15
|
| Rate for Payer: Group Health Inc Medicare |
$10,503.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,005.15
|
|
|
SP VASCU EMBO VENOUS
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37241 TC
|
| Hospital Charge Code |
41104013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$16,505.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,505.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,005.15
|
| Rate for Payer: Aetna Government |
$15,005.15
|
| 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 |
$15,005.15
|
| Rate for Payer: Group Health Inc Medicare |
$10,503.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,005.15
|
|
|
SP VEIN X-RAY NECK
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75860 TC
|
| Hospital Charge Code |
41543352
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.62 |
| 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: 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: Fidelis CHP/HARP/Medicaid |
$81.62
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.69
|
|
|
SP VEIN X-RAY SKULL
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75870 TC
|
| Hospital Charge Code |
41543353
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.71 |
| 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: 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: Fidelis CHP/HARP/Medicaid |
$109.71
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.90
|
|
|
SP VEN ACCE-CENT PERC >2YR(LOC CU
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 36556
|
| Hospital Charge Code |
30102469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.69 |
| Max. Negotiated Rate |
$3,686.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,686.08
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,686.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
SP VEN ACCE-CENT PERC >2YR(LOC CU
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36556 TC
|
| Hospital Charge Code |
41547709
|
|
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 |
$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 VEN ACCE-CENTRAL PERC<2YR (LOC
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 36555 TC
|
| Hospital Charge Code |
41547710
|
|
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 |
$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 VEN ACCE-REV IMP VEN ACCE PORT
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36575 TC
|
| Hospital Charge Code |
41547711
|
|
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 VENOUS BLOOD SAMPLING
|
Facility
OP
|
$600.79
|
|
|
Service Code
|
HCPCS 36500 TC
|
| Hospital Charge Code |
41542602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.28 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.40
|
| Rate for Payer: Aetna Government |
$300.40
|
| 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 |
$300.40
|
| Rate for Payer: Group Health Inc Medicare |
$210.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.40
|
|
|
SP VENOUS PRT RMV
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36590 TC
|
| Hospital Charge Code |
41549848
|
|
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 VENOUS PUNCTURE >1ST
|
Facility
OP
|
$2,363.06
|
|
|
Service Code
|
HCPCS 36012 TC
|
| Hospital Charge Code |
41542688
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$827.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,299.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,181.53
|
| Rate for Payer: Aetna Government |
$1,181.53
|
| 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 |
$1,181.53
|
| Rate for Payer: Group Health Inc Medicare |
$827.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,181.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,181.53
|
|
|
SP VENOUS PUNCTURE 1ST
|
Facility
OP
|
$2,814.83
|
|
|
Service Code
|
HCPCS 36011 TC
|
| Hospital Charge Code |
41542687
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$985.19 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,548.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,407.42
|
| Rate for Payer: Aetna Government |
$1,407.42
|
| 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 |
$1,407.42
|
| Rate for Payer: Group Health Inc Medicare |
$985.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,407.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,407.42
|
|
|
SP VEN PORT > 5 YRS OLD
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36571 TC
|
| Hospital Charge Code |
41549842
|
|
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 VERTEB AUG LUMBAR
|
Facility
OP
|
$18,618.83
|
|
|
Service Code
|
HCPCS 22514 TC
|
| Hospital Charge Code |
41543554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$10,240.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,240.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,309.42
|
| Rate for Payer: Aetna Government |
$9,309.42
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$9,309.42
|
| Rate for Payer: Group Health Inc Medicare |
$6,516.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,309.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,309.42
|
|
|
SP VERTEB AUGMENT EACH ADDL
|
Facility
OP
|
$13,964.12
|
|
|
Service Code
|
HCPCS 22515 TC
|
| Hospital Charge Code |
41543555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$7,680.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,680.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,982.06
|
| Rate for Payer: Aetna Government |
$6,982.06
|
| 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 |
$6,982.06
|
| Rate for Payer: Group Health Inc Medicare |
$4,887.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,982.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,982.06
|
|
|
SP VERTEB AUG THORACIC
|
Facility
OP
|
$18,618.83
|
|
|
Service Code
|
HCPCS 22513 TC
|
| Hospital Charge Code |
41543553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$10,240.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,240.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,309.42
|
| Rate for Payer: Aetna Government |
$9,309.42
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$9,309.42
|
| Rate for Payer: Group Health Inc Medicare |
$6,516.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,309.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,309.42
|
|
