|
EQ BRONCH BRUSH/BIOPSY ADD ON
|
Facility
OP
|
$218.78
|
|
|
Service Code
|
HCPCS 31632 TC
|
| Hospital Charge Code |
41109932
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.57 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$120.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$109.39
|
| Rate for Payer: Aetna Government |
$109.39
|
| 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 |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$109.39
|
| Rate for Payer: Group Health Inc Medicare |
$76.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.39
|
|
|
EQ BRONCHOSCOPY BILAT
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41107469
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.61 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| 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
|
|
|
EQ BRONCHOSCOPY UNI
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41102010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.61 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| 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
|
|
|
EQ BRUSH BIOPSY,TRANSCATH,RENAL
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41107652
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.13 |
| 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 |
$100.13
|
| 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 |
$111.26
|
|
|
EQ CAVERNOGOGRAM
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 74445 TC
|
| Hospital Charge Code |
41107482
|
|
Hospital Revenue Code
|
320
|
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| 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
|
|
|
EQ CERVICAL MYELOGRAM
|
Facility
OP
|
$2,062.03
|
|
|
Service Code
|
HCPCS 72240 TC
|
| Hospital Charge Code |
41102212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.06 |
| Max. Negotiated Rate |
$1,649.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,134.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,031.02
|
| Rate for Payer: Aetna Government |
$1,031.02
|
| Rate for Payer: Cash Price |
$925.92
|
| Rate for Payer: Cash Price |
$925.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,649.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,402.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.06
|
| Rate for Payer: Group Health Inc Commercial |
$1,031.02
|
| Rate for Payer: Group Health Inc Medicare |
$721.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,031.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.85
|
|
|
EQ CHANGE BILIARY DR. CTH
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Hospital Charge Code |
41102626
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$325.20
|
| Rate for Payer: Aetna Government |
$325.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.76
|
| Rate for Payer: Group Health Inc Commercial |
$325.20
|
| Rate for Payer: Group Health Inc Medicare |
$227.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.07
|
|
|
EQ CHANGE CYSTOSTOMY TUBE
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Hospital Charge Code |
41107646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$325.20
|
| Rate for Payer: Aetna Government |
$325.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.76
|
| Rate for Payer: Group Health Inc Commercial |
$325.20
|
| Rate for Payer: Group Health Inc Medicare |
$227.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.07
|
|
|
EQ CHANGE GASTRO TUBE
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Hospital Charge Code |
41102708
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$325.20
|
| Rate for Payer: Aetna Government |
$325.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.76
|
| Rate for Payer: Group Health Inc Commercial |
$325.20
|
| Rate for Payer: Group Health Inc Medicare |
$227.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.07
|
|
|
EQ CHANGE URETEROSTOMY CATH
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Hospital Charge Code |
41107640
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$325.20
|
| Rate for Payer: Aetna Government |
$325.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.76
|
| Rate for Payer: Group Health Inc Commercial |
$325.20
|
| Rate for Payer: Group Health Inc Medicare |
$227.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.07
|
|
|
EQ CHANGE URTRLSTNT 1/EA/CONDUIT
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Hospital Charge Code |
41108035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$325.20
|
| Rate for Payer: Aetna Government |
$325.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.76
|
| Rate for Payer: Group Health Inc Commercial |
$325.20
|
| Rate for Payer: Group Health Inc Medicare |
$227.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.07
|
|
|
EQ CHOLANGIO ADDL SET INTRAOPT
|
Facility
OP
|
$306.05
|
|
|
Service Code
|
HCPCS 74301 TC
|
| Hospital Charge Code |
41107681
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.12 |
| Max. Negotiated Rate |
$244.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$168.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.02
|
| Rate for Payer: Aetna Government |
$153.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$244.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$208.11
|
| Rate for Payer: Group Health Inc Commercial |
$153.02
|
| Rate for Payer: Group Health Inc Medicare |
$107.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.02
|
|
|
EQ CHOLANGIOGRAM O.R.
|
Facility
OP
|
$306.05
|
|
|
Service Code
|
HCPCS 74300 TC
|
| Hospital Charge Code |
41102514
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.12 |
| Max. Negotiated Rate |
$244.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$168.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.02
|
| Rate for Payer: Aetna Government |
$153.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$244.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$208.11
|
| Rate for Payer: Group Health Inc Commercial |
$153.02
|
| Rate for Payer: Group Health Inc Medicare |
$107.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.02
|
|
|
EQ CHOLANGIOGRAPHY INTRAOPT
|
Facility
OP
|
$306.05
|
|
|
Service Code
|
HCPCS 74300 TC
|
| Hospital Charge Code |
41107680
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.12 |
| Max. Negotiated Rate |
$244.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$168.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.02
|
| Rate for Payer: Aetna Government |
$153.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$244.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$208.11
|
| Rate for Payer: Group Health Inc Commercial |
$153.02
|
| Rate for Payer: Group Health Inc Medicare |
$107.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.02
|
|
|
EQ COAGULATION ACTIVATED ACT
|
Facility
OP
|
$10.70
|
|
|
Service Code
|
HCPCS 85347 TC
|
| Hospital Charge Code |
41107470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.35
|
| Rate for Payer: Aetna Government |
$5.35
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.28
|
| Rate for Payer: Group Health Inc Commercial |
$5.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.35
|
|
|
EQ COLONIC STENT
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74270 TC
|
| Hospital Charge Code |
41107676
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.99 |
| Max. Negotiated Rate |
$441.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.95
|
| Rate for Payer: Aetna Government |
$275.95
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cash Price |
$212.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$441.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$375.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.99
|
| Rate for Payer: Group Health Inc Commercial |
$275.95
|
| Rate for Payer: Group Health Inc Medicare |
$193.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.21
|
|
|
EQ CONVERTION TO G-J TUBE
|
Facility
OP
|
$697.79
|
|
|
Service Code
|
HCPCS 74355 TC
|
| Hospital Charge Code |
41107660
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.23 |
| Max. Negotiated Rate |
$558.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$383.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$348.90
|
| Rate for Payer: Aetna Government |
$348.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$558.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$474.50
|
| Rate for Payer: Group Health Inc Commercial |
$348.90
|
| Rate for Payer: Group Health Inc Medicare |
$244.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.90
|
|
|
EQ CONVERT J-TUBE FR EXIST G-TUBE
|
Facility
OP
|
$697.79
|
|
|
Service Code
|
HCPCS 74355 TC
|
| Hospital Charge Code |
41107656
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.23 |
| Max. Negotiated Rate |
$558.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$383.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$348.90
|
| Rate for Payer: Aetna Government |
$348.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$558.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$474.50
|
| Rate for Payer: Group Health Inc Commercial |
$348.90
|
| Rate for Payer: Group Health Inc Medicare |
$244.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.90
|
|
|
EQ CV CATHINJCKTIP PERIP VEIN
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75820 TC
|
| Hospital Charge Code |
41109858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$1,527.72 |
| 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 |
$1,527.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,298.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.24
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.71
|
|
|
EQ CV CAT INJ/CKTIPRA/SVC
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75827 TC
|
| Hospital Charge Code |
41109857
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.89 |
| Max. Negotiated Rate |
$1,527.72 |
| 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 |
$1,527.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,298.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.89
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.10
|
|
|
EQ CYSTOGRAM
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74430 TC
|
| Hospital Charge Code |
41102134
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.54 |
| Max. Negotiated Rate |
$925.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.26
|
| Rate for Payer: Aetna Government |
$578.26
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$925.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.54
|
| Rate for Payer: Group Health Inc Commercial |
$578.26
|
| Rate for Payer: Group Health Inc Medicare |
$404.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.82
|
|
|
EQ CYSTOGRAM VOID
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74455 TC
|
| Hospital Charge Code |
41102156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.76 |
| 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 |
$99.76
|
| 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 |
$110.85
|
|
|
EQ DENVER SHUNT
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 75809 TC
|
| Hospital Charge Code |
41107474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.13 |
| 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 |
$66.13
|
| 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 |
$73.48
|
|
|
EQ DILATATION OF URTERS
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 74485 TC
|
| Hospital Charge Code |
41102738
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$4,292.46 |
| 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 |
$4,292.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,648.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.78
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.76
|
|
|
EQ DILATION
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 74360 TC
|
| Hospital Charge Code |
41102522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.64 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$325.20
|
| Rate for Payer: Aetna Government |
$325.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.27
|
| Rate for Payer: Group Health Inc Commercial |
$325.20
|
| Rate for Payer: Group Health Inc Medicare |
$227.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.20
|
|
