|
US RETROPERITONEL LIMITED
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Hospital Charge Code |
41304012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.45 |
| 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 |
$35.45
|
| 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 |
$39.39
|
|
|
US SCROTUM
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76870 TC
|
| Hospital Charge Code |
41304034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$79.06 |
| 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 |
$79.06
|
| 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 |
$87.85
|
|
|
US SPINAL SONO
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76800 TC
|
| Hospital Charge Code |
41304026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.53 |
| 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 |
$107.53
|
| 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 |
$119.48
|
|
|
USTEKINUMAB IV INJ
|
Facility
OP
|
$76.95
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
41650211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$50.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.62
|
| Rate for Payer: Aetna Government |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.62
|
| Rate for Payer: EmblemHealth Commercial |
$12.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.25
|
| Rate for Payer: Group Health Inc Commercial |
$12.62
|
| Rate for Payer: Group Health Inc Medicare |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.73
|
| Rate for Payer: Healthfirst QHP |
$12.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.24
|
| Rate for Payer: SOMOS Essential |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
|
|
USTEKINUMAB IV INJ
|
Facility
OP
|
$76.95
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
41640211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$50.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.62
|
| Rate for Payer: Aetna Government |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.62
|
| Rate for Payer: EmblemHealth Commercial |
$12.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.25
|
| Rate for Payer: Group Health Inc Commercial |
$12.62
|
| Rate for Payer: Group Health Inc Medicare |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.73
|
| Rate for Payer: Healthfirst QHP |
$12.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.24
|
| Rate for Payer: SOMOS Essential |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
|
|
USTEKINUMAB IV INJ
|
Facility
IP
|
$76.95
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
41640211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$38.48 |
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.48
|
|
|
USTEKINUMAB IV INJ
|
Facility
IP
|
$76.95
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
41650211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$38.48 |
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.48
|
|
|
US THORACENTESIS FOR ASPIRATION
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
41304048
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.47
|
| Rate for Payer: Aetna Government |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$726.47
|
| Rate for Payer: EmblemHealth Commercial |
$726.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.56
|
| Rate for Payer: Group Health Inc Commercial |
$726.47
|
| Rate for Payer: Group Health Inc Medicare |
$726.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.50
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.18
|
| Rate for Payer: Wellcare Medicare |
$690.15
|
|
|
US THORACENTESIS W/IMAGE GUIDE
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
30105660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.47
|
| Rate for Payer: Aetna Government |
$726.47
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$726.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$726.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.56
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.18
|
| Rate for Payer: Wellcare Medicare |
$690.15
|
|
|
US THORACENTESIS W/IMAGE GUIDE
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
30305660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.47
|
| Rate for Payer: Aetna Government |
$726.47
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$726.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$726.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.56
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.18
|
| Rate for Payer: Wellcare Medicare |
$690.15
|
|
|
US THYROID
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76536 TC
|
| Hospital Charge Code |
41301509
|
|
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 TRANSCRANIAL (NEONATAL)
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93886 TC
|
| Hospital Charge Code |
41307397
|
|
Hospital Revenue Code
|
920
|
| 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: 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 |
$250.85
|
| 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 |
$278.72
|
|
|
US TRANSRECTAL
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76872 TC
|
| Hospital Charge Code |
41304036
|
|
Hospital Revenue Code
|
402
|
| 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 |
$188.44
|
| 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 |
$209.38
|
|
|
US TRANS VAGINAL
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76830 TC
|
| Hospital Charge Code |
41304016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$97.18 |
| 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 |
$97.18
|
| 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 |
$107.98
|
|
|
US TRANSVAGINAL OB
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76817 TC
|
| Hospital Charge Code |
41308742
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.91 |
| 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 |
$63.91
|
| 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 |
$71.01
|
|
|
US ULTRASONIC PACHYMETRY
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 76514 TC
|
| Hospital Charge Code |
41309806
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$55.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.82
|
| Rate for Payer: Aetna Government |
$34.82
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.40
|
| Rate for Payer: Group Health Inc Commercial |
$34.82
|
| Rate for Payer: Group Health Inc Medicare |
$24.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.89
|
|
|
US UP EXTREM ARTERIES UNI
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93931 TC
|
| Hospital Charge Code |
41307389
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.30 |
| 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 |
$112.30
|
| 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 |
$124.78
|
|
|
US UPR/LXTR ART STDY 3+ LVLS
|
Facility
OP
|
$422.98
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
41302363
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.47 |
| Max. Negotiated Rate |
$338.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$232.64
|
| 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 |
$338.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$287.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.47
|
| 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 |
$211.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.30
|
| 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 UPR/L XTREMITY ART 2 LEVELS
|
Facility
OP
|
$339.32
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
41302361
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$91.75 |
| Max. Negotiated Rate |
$271.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
US URINE CAPACITY MEASURE
|
Facility
OP
|
$165.05
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
30306687
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$82.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
US URINE CAPACITY MEASURE
|
Facility
OP
|
$165.05
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
40124278
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
US VENOUS PRT RMV
|
Facility
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36590 TC
|
| Hospital Charge Code |
41309773
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$668.38 |
| Max. Negotiated Rate |
$2,915.00 |
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| 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
|
|
|
US VV CENT VAS/CAR UNI
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93882 TC
|
| Hospital Charge Code |
41307801
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$111.93 |
| 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 |
$111.93
|
| 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 |
$124.37
|
|
|
US VV CENT VASC/CAR BIL
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93880 TC
|
| Hospital Charge Code |
41307800
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$171.37 |
| 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 |
$171.37
|
| 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 |
$190.41
|
|
|
US VV PVR ARTER BILAT
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93923 TC
|
| Hospital Charge Code |
41307805
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.95
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.17
|
|
