|
US DUP HEMO ACCESS ART/VEIN
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93990 TC
|
| Hospital Charge Code |
41301512
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: 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 |
$137.44
|
| 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 |
$152.71
|
|
|
US ECHOENCEPHALOGRAPHY
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76506 TC
|
| Hospital Charge Code |
41308751
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$93.11 |
| 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 |
$93.11
|
| 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 |
$103.46
|
|
|
US ECHO EXAM OF EYE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76519 TC
|
| Hospital Charge Code |
41309734
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$41.73 |
| 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 |
$41.73
|
| 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 |
$46.37
|
|
|
US EMERGENCY BREAST, LTD
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76642 TC
|
| Hospital Charge Code |
41308070
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.10 |
| 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: 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: Fidelis CHP/HARP/Medicaid |
$59.10
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.67
|
|
|
US EXAM CHEST W/DOCMNT
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76604
|
| Hospital Charge Code |
30300154
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$186.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
US EXTREM. UPPER ARTERIES BILAT.
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93930 TC
|
| Hospital Charge Code |
41304040
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$176.91 |
| 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 |
$176.91
|
| 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 |
$196.57
|
|
|
US FETAL BIO PROFILE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76818 TC
|
| Hospital Charge Code |
41304030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.59 |
| 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 |
$74.59
|
| 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 |
$82.88
|
|
|
US GUIDANCE IJ PUNCTURE
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 76942 TC
|
| Hospital Charge Code |
41307722
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.38 |
| 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 |
$31.38
|
| 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 |
$34.87
|
|
|
US GUIDANCE RFA
|
Facility
OP
|
$549.60
|
|
|
Service Code
|
HCPCS 76940 TC
|
| Hospital Charge Code |
41309618
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$274.80
|
| Rate for Payer: Aetna Government |
$274.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$439.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$373.73
|
| Rate for Payer: Group Health Inc Commercial |
$274.80
|
| Rate for Payer: Group Health Inc Medicare |
$192.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$274.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$274.80
|
|
|
US GUIDANCE - VASCULAR ACC
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 76937 TC
|
| Hospital Charge Code |
41309852
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$28.09 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
| Rate for Payer: Aetna Government |
$383.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.09
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.21
|
|
|
US GUIDED COMP PSEUDOANEURYSM
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 76936 TC
|
| Hospital Charge Code |
41307705
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$186.16 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
| Rate for Payer: Aetna Government |
$383.29
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.16
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$206.84
|
|
|
US GUID FOR CYST ASP
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 76942 TC
|
| Hospital Charge Code |
41304066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.38 |
| 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 |
$31.38
|
| 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 |
$34.87
|
|
|
US GUID FOR CYST ASP
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 76942 TC
|
| Hospital Charge Code |
41104066
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.38 |
| 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 |
$31.38
|
| 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 |
$34.87
|
|
|
US GUID RENAL PELVIS ASP
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 76942 TC
|
| Hospital Charge Code |
41304068
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.38 |
| 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 |
$31.38
|
| 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 |
$34.87
|
|
|
US HEAD/NECK/THRYOID
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76536 TC
|
| Hospital Charge Code |
41304020
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.22 |
| 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 |
$94.22
|
| 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 |
$104.69
|
|
|
US HEMO-DIALYSIS EVAL
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93990 TC
|
| Hospital Charge Code |
41201183
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: 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 |
$137.44
|
| 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 |
$152.71
|
|
|
US HYSTEROSONOGRAPHY
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 76831 TC
|
| Hospital Charge Code |
41309621
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$92.01 |
| 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 |
$92.01
|
| 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 |
$102.23
|
|
|
US INFANT HIPS
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76885 TC
|
| Hospital Charge Code |
41307750
|
|
Hospital Revenue Code
|
402
|
| 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: 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: Fidelis CHP/HARP/Medicaid |
$114.15
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.83
|
|
|
US IN O/R (TRANSCATHETER THERAPY)
|
Facility
OP
|
$348.15
|
|
|
Service Code
|
HCPCS 76998 TC
|
| Hospital Charge Code |
41307706
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$121.85 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$174.08
|
| Rate for Payer: Aetna Government |
$174.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.74
|
| Rate for Payer: Group Health Inc Commercial |
$174.08
|
| Rate for Payer: Group Health Inc Medicare |
$121.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.08
|
|
|
US KIDNEYS
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76770 TC
|
| Hospital Charge Code |
41301508
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.76 |
| 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 |
$82.76
|
| 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 |
$91.96
|
|
|
US LOW EXTREM ARTERIES BI
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93925 TC
|
| Hospital Charge Code |
41307390
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$226.82 |
| 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 |
$226.82
|
| 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 |
$252.02
|
|
|
US LOW EXTREM ARTERIES UNI
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93926 TC
|
| Hospital Charge Code |
41307391
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: 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 |
$134.11
|
| 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 |
$149.01
|
|
|
US LWR XTR VASC STDY BILAT
|
Facility
OP
|
$801.55
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
41302365
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$144.51 |
| Max. Negotiated Rate |
$641.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$641.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$545.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
US OBGYN AMNIOCENTESIS DIAGNOSTIC
|
Facility
OP
|
$1,933.73
|
|
|
Service Code
|
HCPCS 59000
|
| Hospital Charge Code |
41301503
|
|
Hospital Revenue Code
|
409
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$929.66
|
| Rate for Payer: Aetna Government |
$929.66
|
| Rate for Payer: Brighton Health Commercial |
$929.66
|
| Rate for Payer: Cash Price |
$929.66
|
| Rate for Payer: Cash Price |
$929.66
|
| Rate for Payer: Cash Price |
$929.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$929.66
|
| 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 |
$929.66
|
| Rate for Payer: EmblemHealth Commercial |
$650.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$790.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$790.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$827.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$929.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$827.40
|
| Rate for Payer: Group Health Inc Commercial |
$836.69
|
| Rate for Payer: Group Health Inc Medicare |
$836.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$790.21
|
| Rate for Payer: Healthfirst QHP |
$929.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$929.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$743.73
|
| Rate for Payer: Wellcare Medicare |
$883.18
|
|
|
US OBGYN BIO PHYSICAL PROFILE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76819 TC
|
| Hospital Charge Code |
41108875
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$53.56 |
| 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 |
$53.56
|
| 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 |
$59.51
|
|
