|
EQ PULMONARY BI
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75743 TC
|
| Hospital Charge Code |
41102588
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.88 |
| 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 |
$80.88
|
| 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 |
$89.87
|
|
|
EQ PULMONARY NON-SELECTIV
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75746 TC
|
| Hospital Charge Code |
41102590
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.97 |
| 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 |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| 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: Fidelis CHP/HARP/Medicaid |
$91.97
|
| 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 |
$102.19
|
|
|
EQ PULMONARY UNI
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75741 TC
|
| Hospital Charge Code |
41102586
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.40 |
| 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 |
$79.40
|
| 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 |
$88.22
|
|
|
EQ RADIO. GUIDE ABSCESS DRAIN
|
Facility
OP
|
$453.64
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
41102628
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$362.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$249.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$226.82
|
| Rate for Payer: Aetna Government |
$226.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$362.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$308.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.66
|
| Rate for Payer: Group Health Inc Commercial |
$226.82
|
| Rate for Payer: Group Health Inc Medicare |
$158.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.84
|
|
|
EQ REMOVE CVA LUMEN OBSTR. MATERI
|
Facility
OP
|
$322.23
|
|
|
Service Code
|
HCPCS 75902 TC
|
| Hospital Charge Code |
41109933
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$257.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$177.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$161.12
|
| Rate for Payer: Aetna Government |
$161.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$257.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$219.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.55
|
| Rate for Payer: Group Health Inc Commercial |
$161.12
|
| Rate for Payer: Group Health Inc Medicare |
$112.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.50
|
|
|
EQ REMV. IMPLANT VEN. CATH
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41102834
|
|
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 RENAL, BI W/WO FLUSH
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36252 TC
|
| Hospital Charge Code |
41102574
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
|
EQ RENAL CYST STUDY
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 74470 TC
|
| Hospital Charge Code |
41102729
|
|
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 RENAL, UNI W/WO FLUSH
|
Facility
OP
|
$8,818.00
|
|
|
Service Code
|
HCPCS 36251 TC
|
| Hospital Charge Code |
41102572
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$4,849.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,849.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,409.00
|
| Rate for Payer: Aetna Government |
$4,409.00
|
| 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 |
$4,409.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,086.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,409.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,409.00
|
|
|
EQ RENAL VEN. BIL.
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75833 TC
|
| Hospital Charge Code |
41102692
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.16 |
| 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 |
$87.16
|
| 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 |
$96.85
|
|
|
EQ RENAL VEN. UNI
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75831 TC
|
| Hospital Charge Code |
41102691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.18 |
| 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 |
$77.18
|
| 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 |
$85.76
|
|
|
EQ REP FIGD VEN ACC
|
Facility
OP
|
$329.14
|
|
|
Service Code
|
HCPCS 77001 TC
|
| Hospital Charge Code |
41109855
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.38 |
| Max. Negotiated Rate |
$263.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Government |
$164.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$263.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$223.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.38
|
| Rate for Payer: Group Health Inc Commercial |
$164.57
|
| Rate for Payer: Group Health Inc Medicare |
$115.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.64
|
|
|
EQ REPL DISLODG G-J TUBE SIMPLE
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Hospital Charge Code |
41107662
|
|
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 REPOSIT. CEN. VEN CATH
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41102837
|
|
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 REPOSIT GI FEED TUBE
|
Facility
OP
|
$697.79
|
|
|
Service Code
|
HCPCS 74355 TC
|
| Hospital Charge Code |
41102711
|
|
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 RETROGRADE O.R.
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74450 TC
|
| Hospital Charge Code |
41102152
|
|
Hospital Revenue Code
|
320
|
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| 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
|
|
|
EQ RMVL OF F/B FROM DEEP PENILE T
|
Facility
OP
|
$7,023.35
|
|
|
Service Code
|
HCPCS 54115 TC
|
| Hospital Charge Code |
41546012
|
|
Hospital Revenue Code
|
369
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,862.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,862.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,511.68
|
| Rate for Payer: Aetna Government |
$3,511.68
|
| Rate for Payer: Cash Price |
$3,285.96
|
| Rate for Payer: Cash Price |
$3,285.96
|
| 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 |
$3,511.68
|
| Rate for Payer: Group Health Inc Medicare |
$2,458.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,511.68
|
|
|
EQ SHOULDER ARTHROGRAM
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73040 TC
|
| Hospital Charge Code |
41102458
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.14 |
| 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 |
$117.14
|
| 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 |
$130.16
|
|
|
EQ SIALOGRAM
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 70390 TC
|
| Hospital Charge Code |
41102180
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.60 |
| 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 |
$111.60
|
| 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 |
$124.00
|
|
|
EQ SIALOGRAM W/DUCT DIL
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 70390 TC
|
| Hospital Charge Code |
41102820
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.60 |
| 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 |
$111.60
|
| 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 |
$124.00
|
|
|
EQ SINUS OR JUGULAR
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75860 TC
|
| Hospital Charge Code |
41102695
|
|
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 SPINAL ART. SELECTIVE
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75705 TC
|
| Hospital Charge Code |
41102827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.19 |
| Max. Negotiated Rate |
$11,136.56 |
| 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 |
$11,136.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,466.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.19
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.77
|
|
|
EQ SPLENOPORTOGRAPHY
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75810 TC
|
| Hospital Charge Code |
41107686
|
|
Hospital Revenue Code
|
320
|
| 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 |
$3,686.08
|
| 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
|
|
|
EQ SUPERIOR SAGITTAL SINUS
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75870 TC
|
| Hospital Charge Code |
41102696
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.71 |
| 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 |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| 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: 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
|
|
|
EQ SVC
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75827 TC
|
| Hospital Charge Code |
41102600
|
|
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
|
|
