|
EQ GALACTOGRAM MULTIPLE
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 77054 TC
|
| Hospital Charge Code |
41102668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.56 |
| 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 |
$53.56
|
| 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 |
$59.51
|
|
|
EQ GASTROSTOMY CTH CHECK
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Hospital Charge Code |
41107477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.52
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.91
|
|
|
EQ GI TUBE CHANGE W/CONTRAST
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Hospital Charge Code |
41108586
|
|
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 HEPATIC VENOGRAM W/O PRESSURES
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75891 TC
|
| Hospital Charge Code |
41107724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.62 |
| Max. Negotiated Rate |
$6,714.82 |
| 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 |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| 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
|
|
|
EQ HEPATIC VENOGRAM W/PRESSURES
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75889 TC
|
| Hospital Charge Code |
41107725
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$6,714.82 |
| 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 |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.25
|
| 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 |
$90.28
|
|
|
EQ HEPATIC W/HEMO EVAL.
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75889 TC
|
| Hospital Charge Code |
41102699
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$6,714.82 |
| 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 |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.25
|
| 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 |
$90.28
|
|
|
EQ HEPATIC W/O HEMO EVAL.
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75891 TC
|
| Hospital Charge Code |
41102700
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.62 |
| Max. Negotiated Rate |
$6,714.82 |
| 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 |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| 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
|
|
|
EQ HIP ARTHROGRAM
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73525 TC
|
| Hospital Charge Code |
41102476
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.92 |
| 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 |
$114.92
|
| 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 |
$127.69
|
|
|
EQ HYSTEROSALPINGOGRAM
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74740 TC
|
| Hospital Charge Code |
41102534
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.83 |
| 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 |
$86.83
|
| 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 |
$96.48
|
|
|
EQ ILIAC ANEURYSM ENDOVAS RPR
|
Facility
OP
|
$4,627.38
|
|
|
Service Code
|
HCPCS 34701 TC
|
| Hospital Charge Code |
41561858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,619.58 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,545.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,313.69
|
| Rate for Payer: Aetna Government |
$2,313.69
|
| 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 |
$2,313.69
|
| Rate for Payer: Group Health Inc Medicare |
$1,619.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,313.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,313.69
|
|
|
EQ INJEC PROC-EVAL PERIT VEN SHUN
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 75809 TC
|
| Hospital Charge Code |
41107621
|
|
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 INJ OF CONT OR AIR INTO PERITO
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 74190 TC
|
| Hospital Charge Code |
41107619
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$510.50 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
|
|
EQ INPT CONSLT LEAST COMPLX>20MIN
|
Facility
OP
|
$135.20
|
|
|
Service Code
|
HCPCS 99251 TC
|
| Hospital Charge Code |
41102829
|
|
Hospital Revenue Code
|
657
|
| Min. Negotiated Rate |
$47.32 |
| Max. Negotiated Rate |
$108.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.60
|
| Rate for Payer: Aetna Government |
$67.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.94
|
| Rate for Payer: Group Health Inc Commercial |
$67.60
|
| Rate for Payer: Group Health Inc Medicare |
$47.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.60
|
|
|
EQ INPT CONSLT MOD. COMPLEX>40MIN
|
Facility
OP
|
$211.45
|
|
|
Service Code
|
HCPCS 99252 TC
|
| Hospital Charge Code |
41102830
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$74.01 |
| Max. Negotiated Rate |
$169.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.72
|
| Rate for Payer: Aetna Government |
$105.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.79
|
| Rate for Payer: Group Health Inc Commercial |
$105.72
|
| Rate for Payer: Group Health Inc Medicare |
$74.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.72
|
|
|
EQ INPT CONSULT COMPREHENS.>80MIN
|
Facility
OP
|
$462.23
|
|
|
Service Code
|
HCPCS 99254 TC
|
| Hospital Charge Code |
41102832
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$369.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.12
|
| Rate for Payer: Aetna Government |
$231.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$369.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$314.32
|
| Rate for Payer: Group Health Inc Commercial |
$231.12
|
| Rate for Payer: Group Health Inc Medicare |
$161.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.12
|
|
|
EQ INPT CONSULT MOST COMPLX>55MIN
|
Facility
OP
|
$320.35
|
|
|
Service Code
|
HCPCS 99253 TC
|
| Hospital Charge Code |
41102831
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$112.12 |
| Max. Negotiated Rate |
$256.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$160.18
|
| Rate for Payer: Aetna Government |
$160.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$256.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$217.84
|
| Rate for Payer: Group Health Inc Commercial |
$160.18
|
| Rate for Payer: Group Health Inc Medicare |
$112.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.18
|
|
|
EQ INTRALUM. FB REM ESOPH
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 74235 TC
|
| Hospital Charge Code |
41102703
|
|
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
|
|
|
EQ IVC
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75825 TC
|
| Hospital Charge Code |
41102598
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$6,714.82 |
| 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 |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.72
|
| 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 |
$76.35
|
|
|
EQ KNEE ARTHROGRAM
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73580 TC
|
| Hospital Charge Code |
41102324
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.01 |
| 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 |
$109.01
|
| 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 |
$121.12
|
|
|
EQ LAMINECTOMY O.R.
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 72100 TC
|
| Hospital Charge Code |
41102254
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
|
EQ LARYNGOGRAM
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41102036
|
|
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 LITHOTRIPSY - ESWL
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 50590 TC
|
| Hospital Charge Code |
41109868
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$5,028.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,028.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,571.20
|
| Rate for Payer: Aetna Government |
$4,571.20
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,571.20
|
| Rate for Payer: Group Health Inc Medicare |
$3,199.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,571.20
|
|
|
EQ LITH W/URETERAL CATHETIRIZATIO
|
Facility
OP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 52353 TC
|
| Hospital Charge Code |
41109869
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,049.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,049.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,408.26
|
| Rate for Payer: Aetna Government |
$6,408.26
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| 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 |
$6,408.26
|
| Rate for Payer: Group Health Inc Medicare |
$4,485.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,408.26
|
|
|
EQ LUMBAR MYELOGRAM
|
Facility
OP
|
$2,062.03
|
|
|
Service Code
|
HCPCS 72265 TC
|
| Hospital Charge Code |
41102452
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.33 |
| 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 |
$78.33
|
| 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 |
$87.03
|
|
|
EQ LUMBAR PUNCTURE
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41102824
|
|
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
|
|
