|
EQ TANKOFF CATH. REPOSITION
|
Facility
OP
|
$453.64
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
41107491
|
|
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 THORACENTESIS, W/INSERT OF TUB
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41107614
|
|
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 THORACIC AORTOGRAM
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75605 TC
|
| Hospital Charge Code |
41102536
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.08 |
| 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 |
$76.08
|
| 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 |
$84.53
|
|
|
EQ THORACIC MYELOGRAM
|
Facility
OP
|
$2,062.03
|
|
|
Service Code
|
HCPCS 72255 TC
|
| Hospital Charge Code |
41102450
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.40 |
| 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 |
$82.40
|
| 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 |
$91.55
|
|
|
EQ TMJ ARTHOGRAM
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 70332 TC
|
| Hospital Charge Code |
41561914
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$2,915.00 |
| 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: Cash Price |
$283.37
|
| 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 |
$65.76
|
| 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 |
$73.07
|
|
|
EQ TRANSCATHETER BILLIARY BIOPSY
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41107650
|
|
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 TRANSCATHETER BIOPSY
|
Facility
OP
|
$1,528.75
|
|
|
Service Code
|
HCPCS 75970 TC
|
| Hospital Charge Code |
41107694
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$535.06 |
| Max. Negotiated Rate |
$1,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$840.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$764.38
|
| Rate for Payer: Aetna Government |
$764.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,223.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,039.55
|
| Rate for Payer: Group Health Inc Commercial |
$764.38
|
| Rate for Payer: Group Health Inc Medicare |
$535.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.38
|
|
|
EQ TRANSCERV. CATH FALL. TB
|
Facility
OP
|
$1,147.78
|
|
|
Service Code
|
HCPCS 74742 TC
|
| Hospital Charge Code |
41107490
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$401.72 |
| Max. Negotiated Rate |
$918.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$631.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$573.89
|
| Rate for Payer: Aetna Government |
$573.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$918.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$780.49
|
| Rate for Payer: Group Health Inc Commercial |
$573.89
|
| Rate for Payer: Group Health Inc Medicare |
$401.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$573.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$573.89
|
|
|
EQ TRANSHEPATIC PORTO W/HEMO
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75885 TC
|
| Hospital Charge Code |
41107473
|
|
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 TRANSJUGULAR LIVER BIOPSY
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41107654
|
|
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 TRANSLUM. ADD'L PER ART
|
Facility
OP
|
$5,248.77
|
|
|
Service Code
|
HCPCS 37233 TC
|
| Hospital Charge Code |
41102776
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,837.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,624.38
|
| Rate for Payer: Aetna Government |
$2,624.38
|
| 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 |
$2,624.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,837.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.38
|
|
|
EQ TRANSLUM. ADD'L VISC ART
|
Facility
OP
|
$5,248.77
|
|
|
Service Code
|
HCPCS 0235T TC
|
| Hospital Charge Code |
41102777
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,837.07 |
| Max. Negotiated Rate |
$4,199.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,624.38
|
| Rate for Payer: Aetna Government |
$2,624.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,199.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,569.16
|
| Rate for Payer: Group Health Inc Commercial |
$2,624.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,837.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.38
|
|
|
EQ TRANSLUM AORTA
|
Facility
OP
|
$5,248.77
|
|
|
Service Code
|
HCPCS 0235T TC
|
| Hospital Charge Code |
41102767
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,837.07 |
| Max. Negotiated Rate |
$4,199.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,624.38
|
| Rate for Payer: Aetna Government |
$2,624.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,199.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,569.16
|
| Rate for Payer: Group Health Inc Commercial |
$2,624.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,837.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.38
|
|
|
EQ TRANSLUM. FEM-POP ARTERY
|
Facility
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 37227 TC
|
| Hospital Charge Code |
41102771
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$26,553.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,553.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,139.09
|
| Rate for Payer: Aetna Government |
$24,139.09
|
| 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 |
$24,139.09
|
| Rate for Payer: Group Health Inc Medicare |
$16,897.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,139.09
|
|
|
EQ TRANSLUM. TIBIO TK. ART
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37225 TC
|
| Hospital Charge Code |
41102775
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
|
EQ TRLUML PERIP ATHRC ILIAC ART
|
Facility
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 0238T
|
| Hospital Charge Code |
41102769
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$24,139.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
EQ TRLUML PERIP ATHRC RENAL ART
|
Facility
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
41102763
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$15,005.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12,721.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
|
|
EQ TRLUML PERIP ATHRC VISCERAL
|
Facility
OP
|
$5,248.77
|
|
|
Service Code
|
HCPCS 0235T TC
|
| Hospital Charge Code |
41102765
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$2,886.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,624.38
|
| Rate for Payer: Aetna Government |
$2,624.38
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.38
|
|
|
EQUIP. CHGE CONT. VENT.
|
Facility
OP
|
$49.61
|
|
|
Service Code
|
HCPCS A4618
|
| Hospital Charge Code |
40307350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$39.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.41
|
| Rate for Payer: Aetna Government |
$5.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.73
|
| Rate for Payer: Group Health Inc Commercial |
$24.80
|
| Rate for Payer: Group Health Inc Medicare |
$17.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.80
|
|
|
EQ URETHROCYSTOGRAM, RETRO
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74450 TC
|
| Hospital Charge Code |
41107480
|
|
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 URETHROCYSTOGRAM, VOID
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74455 TC
|
| Hospital Charge Code |
41107481
|
|
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 UROGRAPHY ANTEGRADE RS&I
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41102731
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.38 |
| 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 |
$126.38
|
| 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 |
$140.42
|
|
|
EQ UROGRAPHY ANTEGRDE RS&I
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41107642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.38 |
| 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 |
$126.38
|
| 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 |
$140.42
|
|
|
EQ UROGRAPHY ANTGRADE RS&I
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41102524
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$912.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$627.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$570.50
|
| Rate for Payer: Aetna Government |
$570.50
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$912.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$775.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.38
|
| Rate for Payer: Group Health Inc Commercial |
$570.50
|
| Rate for Payer: Group Health Inc Medicare |
$399.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$570.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$570.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.42
|
|
|
EQ UROGRAPHY IV +-KUB TOMOG
|
Facility
OP
|
$551.90
|
|
|
Service Code
|
HCPCS 74400 TC
|
| Hospital Charge Code |
41108536
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.34 |
| 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 |
$126.34
|
| 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 |
$140.38
|
|
