|
TAPE UMBILICAL COTTON
|
Facility
OP
|
$2.85
|
|
| Hospital Charge Code |
64902580
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.42
|
| Rate for Payer: Aetna Government |
$1.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.94
|
| Rate for Payer: Group Health Inc Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Medicare |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.42
|
|
|
TAP FOR 4.0MM NCB DEEP TH
|
Facility
IP
|
$393.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.53 |
| Max. Negotiated Rate |
$196.53 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.53
|
|
|
TAP FOR 4.0MM NCB DEEP TH
|
Facility
OP
|
$393.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006766
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$412.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$226.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$412.71
|
| Rate for Payer: Group Health Inc Commercial |
$196.53
|
| Rate for Payer: Group Health Inc Medicare |
$137.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.49
|
|
|
TAP SERRATO
|
Facility
IP
|
$3,292.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$1,646.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,646.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,646.25
|
|
|
TAP SERRATO
|
Facility
OP
|
$3,292.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,457.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,810.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,646.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,893.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,457.12
|
| Rate for Payer: Group Health Inc Commercial |
$1,646.25
|
| Rate for Payer: Group Health Inc Medicare |
$1,152.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,646.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,646.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,140.12
|
|
|
TAP SPINE
|
Facility
IP
|
$4,355.00
|
|
|
Service Code
|
HCPCS C1821
|
| Hospital Charge Code |
64907467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,177.50 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,177.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,177.50
|
|
|
TAP SPINE
|
Facility
OP
|
$4,355.00
|
|
|
Service Code
|
HCPCS C1821
|
| Hospital Charge Code |
64907467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.25 |
| Max. Negotiated Rate |
$4,572.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,395.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,609.27
|
| Rate for Payer: Aetna Government |
$1,609.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,177.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,504.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,572.75
|
| Rate for Payer: Group Health Inc Commercial |
$2,177.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,524.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,177.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,177.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,830.75
|
|
|
TAP STRAIGHT 4.0
|
Facility
OP
|
$807.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$847.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$444.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$403.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$464.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$847.88
|
| Rate for Payer: Group Health Inc Commercial |
$403.75
|
| Rate for Payer: Group Health Inc Medicare |
$282.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$403.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$524.88
|
|
|
TAP STRAIGHT 4.0
|
Facility
IP
|
$807.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.75 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$403.75
|
|
|
TAP SURGICAL 3.5MM DIA TITANIUM
|
Facility
OP
|
$900.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$945.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$495.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$450.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$517.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$945.08
|
| Rate for Payer: Group Health Inc Commercial |
$450.04
|
| Rate for Payer: Group Health Inc Medicare |
$315.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$585.05
|
|
|
TAP SURGICAL 3.5MM DIA TITANIUM
|
Facility
IP
|
$900.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.04 |
| Max. Negotiated Rate |
$450.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.04
|
|
|
TAP SURGICAL 5.5MM DIA SPINAL
|
Facility
OP
|
$1,811.15
|
|
| Hospital Charge Code |
64906011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$633.90 |
| Max. Negotiated Rate |
$1,448.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$996.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$905.58
|
| Rate for Payer: Aetna Government |
$905.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,448.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,231.58
|
| Rate for Payer: Group Health Inc Commercial |
$905.58
|
| Rate for Payer: Group Health Inc Medicare |
$633.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$905.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$905.58
|
|
|
T & A, UNDER AGE 12
|
Facility
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 42820
|
| Hospital Charge Code |
40109040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$323.43 |
| Max. Negotiated Rate |
$7,345.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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: Elderplan Medicare Advantage |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$323.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$359.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
TAY SACHS, DNA ANALYSIS
|
Facility
OP
|
$128.63
|
|
|
Service Code
|
HCPCS 81255
|
| Hospital Charge Code |
40603053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$102.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.45
|
| Rate for Payer: Aetna Government |
$51.45
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Cash Price |
$51.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$51.45
|
| Rate for Payer: EmblemHealth Commercial |
$51.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.79
|
| Rate for Payer: Group Health Inc Commercial |
$51.45
|
| Rate for Payer: Group Health Inc Medicare |
$51.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.45
|
| Rate for Payer: Healthfirst QHP |
$51.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.16
|
| Rate for Payer: Wellcare Medicare |
$46.30
|
|
|
TBA 1ST ARTERY (NOT DIALYSIS)
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
40034512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.84 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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: Elderplan Medicare Advantage |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$354.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
TBA 1ST ARTERY (NOT DIALYSIS)
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
66524706
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.84 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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: Elderplan Medicare Advantage |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$354.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
TBA_1ST_ARTERY_(NOT DIALYSIS)
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
66574713
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.84 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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: Elderplan Medicare Advantage |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$354.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
66524704
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.85 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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: Elderplan Medicare Advantage |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$382.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$425.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
TBA 1ST ARTERY (NOT LE)
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
40034510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.85 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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: Elderplan Medicare Advantage |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$382.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$425.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
TBA_1ST_ARTERY_(NOT LE)
|
Facility
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37246
|
| Hospital Charge Code |
66574711
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.85 |
| Max. Negotiated Rate |
$7,502.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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: Elderplan Medicare Advantage |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$382.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$425.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
OP
|
$345.23
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
40034509
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.83 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.44
|
| Rate for Payer: Aetna Government |
$135.44
|
| 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 |
$157.89
|
| Rate for Payer: Group Health Inc Commercial |
$172.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.43
|
|
|
TBA CENTRAL DIALYSIS SEG ADDON
|
Facility
OP
|
$345.23
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
66524703
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.83 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.44
|
| Rate for Payer: Aetna Government |
$135.44
|
| 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 |
$157.89
|
| Rate for Payer: Group Health Inc Commercial |
$172.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.43
|
|
|
TBA_CENTRAL_DIALYSIS_SEG_ADDON
|
Facility
OP
|
$345.23
|
|
|
Service Code
|
HCPCS 36907
|
| Hospital Charge Code |
66574710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.83 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.44
|
| Rate for Payer: Aetna Government |
$135.44
|
| 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 |
$157.89
|
| Rate for Payer: Group Health Inc Commercial |
$172.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.43
|
|
|
TBA EA ADD ARTERY (NOT LE)
|
Facility
OP
|
$487.45
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
40034511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.71
|
| Rate for Payer: Aetna Government |
$191.71
|
| 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 |
$192.25
|
| Rate for Payer: Group Health Inc Commercial |
$243.72
|
| Rate for Payer: Group Health Inc Medicare |
$170.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.61
|
|
|
TBA EA ADD ARTERY (NOT LE)
|
Facility
OP
|
$487.45
|
|
|
Service Code
|
HCPCS 37247
|
| Hospital Charge Code |
66524705
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.71
|
| Rate for Payer: Aetna Government |
$191.71
|
| 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 |
$192.25
|
| Rate for Payer: Group Health Inc Commercial |
$243.72
|
| Rate for Payer: Group Health Inc Medicare |
$170.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.61
|
|
