|
UROLOK II ADAPTOR
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
40201007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.00
|
| Rate for Payer: Aetna Government |
$18.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.48
|
| Rate for Payer: Group Health Inc Commercial |
$18.00
|
| Rate for Payer: Group Health Inc Medicare |
$12.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.00
|
|
|
UROMAX 20
|
Facility
OP
|
$927.50
|
|
| Hospital Charge Code |
64903048
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$324.62 |
| Max. Negotiated Rate |
$742.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$510.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$463.75
|
| Rate for Payer: Aetna Government |
$463.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$742.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$630.70
|
| Rate for Payer: Group Health Inc Commercial |
$463.75
|
| Rate for Payer: Group Health Inc Medicare |
$324.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$463.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$463.75
|
|
|
URO SHEATH
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40206390
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
URSODIOL 250 MG TAB
|
Facility
OP
|
$3.09
|
|
| Hospital Charge Code |
41644613
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.54
|
| Rate for Payer: Aetna Government |
$1.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.10
|
| Rate for Payer: Group Health Inc Commercial |
$1.54
|
| Rate for Payer: Group Health Inc Medicare |
$1.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.01
|
|
|
URSODIOL 250 MG TAB
|
Facility
OP
|
$3.09
|
|
| Hospital Charge Code |
41654613
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.54
|
| Rate for Payer: Aetna Government |
$1.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.10
|
| Rate for Payer: Group Health Inc Commercial |
$1.54
|
| Rate for Payer: Group Health Inc Medicare |
$1.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.01
|
|
|
URSODIOL 25 MG/ML SUSP NEONATAL
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41652484
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
URSODIOL 25 MG/ML SUSP NEONATAL
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41642484
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
URSODIOL 300 MG CAP
|
Facility
OP
|
$0.48
|
|
| Hospital Charge Code |
41654038
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
URSODIOL 300 MG CAP
|
Facility
OP
|
$0.48
|
|
| Hospital Charge Code |
41644038
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
US ABD AORTIC ANEURYSM
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76706 TC
|
| Hospital Charge Code |
41301514
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.15 |
| 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 |
$90.15
|
| 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 |
$100.17
|
|
|
US ABDOMINAL COMPLETE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76700 TC
|
| Hospital Charge Code |
41304002
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.94 |
| 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 |
$87.94
|
| 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 |
$97.71
|
|
|
US ABDOMINAL LIMITED
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Hospital Charge Code |
41304004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.24 |
| 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 |
$67.24
|
| 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 |
$74.71
|
|
|
US AORTA/IVC/ILIAC COMPLETE
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93978 TC
|
| Hospital Charge Code |
41307395
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$159.91 |
| 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 |
$159.91
|
| 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 |
$177.68
|
|
|
US AORTA/IVC/ILIAC LIMITED
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93979 TC
|
| Hospital Charge Code |
41307396
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.27 |
| 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 |
$105.27
|
| 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 |
$116.97
|
|
|
US BIOPSY - NEEDLE
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 76942 TC
|
| Hospital Charge Code |
41304052
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$915.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$572.20
|
| Rate for Payer: Aetna Government |
$572.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$915.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$778.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.38
|
| Rate for Payer: Group Health Inc Commercial |
$572.20
|
| Rate for Payer: Group Health Inc Medicare |
$400.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.87
|
|
|
US BONE DENSITY MEASURE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76977 TC
|
| Hospital Charge Code |
41309813
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$5.14 |
| 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 |
$5.14
|
| 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 |
$5.71
|
|
|
US BREAST COMPLETE BILAT
|
Facility
OP
|
$678.90
|
|
|
Service Code
|
HCPCS 76641 TC
|
| Hospital Charge Code |
41301632
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.85 |
| Max. Negotiated Rate |
$543.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$373.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.45
|
| Rate for Payer: Aetna Government |
$339.45
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$543.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$461.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.85
|
| Rate for Payer: Group Health Inc Commercial |
$339.45
|
| Rate for Payer: Group Health Inc Medicare |
$237.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$339.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$339.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.39
|
|
|
US BREAST COMPLETE UNI
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76641 TC
|
| Hospital Charge Code |
41304006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.85 |
| 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 |
$76.85
|
| 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 |
$85.39
|
|
|
US BREAST LIMITED UNI
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76642 TC
|
| Hospital Charge Code |
41309978
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$120.86
|
| Rate for Payer: Aetna Government |
$120.86
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.10
|
| Rate for Payer: Group Health Inc Commercial |
$120.86
|
| Rate for Payer: Group Health Inc Medicare |
$84.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.67
|
|
|
US CENTRAL VAS/CAROTID
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93880 TC
|
| Hospital Charge Code |
41304046
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$171.37 |
| 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 |
$171.37
|
| 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 |
$190.41
|
|
|
US CENTRAL VASC/CAROTID UNI
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93882 TC
|
| Hospital Charge Code |
41307393
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$111.93 |
| 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 |
$111.93
|
| 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 |
$124.37
|
|
|
US CHEST
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76604 TC
|
| Hospital Charge Code |
41304022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.86 |
| 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 |
$32.86
|
| 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 |
$36.51
|
|
|
USCI
|
Facility
OP
|
$53.87
|
|
| Hospital Charge Code |
40207020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$43.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.94
|
| Rate for Payer: Aetna Government |
$26.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.63
|
| Rate for Payer: Group Health Inc Commercial |
$26.94
|
| Rate for Payer: Group Health Inc Medicare |
$18.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.94
|
|
|
US DUP ABD/PEL/SCO/ RETRO ART CO
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93975 TC
|
| Hospital Charge Code |
41301510
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$235.69 |
| 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 |
$235.69
|
| 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 |
$261.88
|
|
|
US DUP ABD/PEL/SCO/RETRO ART LIM
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93976 TC
|
| Hospital Charge Code |
41301511
|
|
Hospital Revenue Code
|
921
|
| 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 |
$134.85
|
| 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 |
$149.83
|
|
