|
SP AORTA CATHETER
|
Facility
|
OP
|
$1,965.63
|
|
|
Service Code
|
HCPCS 36200 TC
|
| Hospital Charge Code |
41542689
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$677.64 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$677.64
|
| Rate for Payer: Aetna Government |
$677.64
|
| Rate for Payer: Brighton Health Commercial |
$1,474.22
|
| 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 |
$982.82
|
| Rate for Payer: Group Health Inc Medicare |
$687.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$982.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$982.82
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP AORTA/IVC/ILIA COMP
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93978 TC
|
| Hospital Charge Code |
41201174
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
SP AORTA/IVC/ILIA COMP
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93978 TC
|
| Hospital Charge Code |
41201174
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
SP AORTA/IVC/ILIA LTD
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93979 TC
|
| Hospital Charge Code |
41201175
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| 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: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$254.59
|
| Rate for Payer: Cash Price |
$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 |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$127.14
|
| 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 |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare 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
|
|
|
SP AORTA/IVC/ILIA LTD
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93979 TC
|
| Hospital Charge Code |
41201175
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
SP AORTA TRANSLUMBAR
|
Facility
|
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 0236T
|
| Hospital Charge Code |
41542766
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$22,507.72 |
| 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: Affinity Essential Plan 1&2 |
$8,905.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,905.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,905.39
|
| Rate for Payer: Brighton Health Commercial |
$22,507.72
|
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,721.98
|
| Rate for Payer: EmblemHealth Commercial |
$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 |
$12,721.98
|
| Rate for Payer: Group Health Inc Medicare |
$12,721.98
|
| 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: Humana Medicare |
$12,976.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare 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
|
|
|
SP AORTA TRANSLUMBAR
|
Facility
|
IP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 0236T
|
| Hospital Charge Code |
41542766
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,721.98
|
|
|
SP ARTER. ABOVE DIAPH. 1S
|
Facility
|
OP
|
$3,471.23
|
|
|
Service Code
|
HCPCS 36215 TC
|
| Hospital Charge Code |
41542678
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,113.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,215.63
|
| Rate for Payer: Aetna Government |
$1,215.63
|
| Rate for Payer: Brighton Health Commercial |
$2,603.42
|
| 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 |
$1,735.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,214.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,735.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,735.62
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ARTER. ABOVE DIAPH. 2N
|
Facility
|
OP
|
$3,790.55
|
|
|
Service Code
|
HCPCS 36216 TC
|
| Hospital Charge Code |
41542679
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,113.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,293.60
|
| Rate for Payer: Aetna Government |
$1,293.60
|
| Rate for Payer: Brighton Health Commercial |
$2,842.91
|
| 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 |
$1,895.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,326.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,895.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,895.28
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ARTER. ABOVE DIAPH. 3R
|
Facility
|
OP
|
$6,223.85
|
|
|
Service Code
|
HCPCS 36217 TC
|
| Hospital Charge Code |
41542680
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,113.00 |
| Max. Negotiated Rate |
$4,667.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,128.56
|
| Rate for Payer: Aetna Government |
$2,128.56
|
| Rate for Payer: Brighton Health Commercial |
$4,667.89
|
| 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 |
$3,111.92
|
| Rate for Payer: Group Health Inc Medicare |
$2,178.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,111.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,111.92
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ARTER. ABOVE DIAPH. >3RD
|
Facility
|
OP
|
$577.70
|
|
|
Service Code
|
HCPCS 36218 TC
|
| Hospital Charge Code |
41542681
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$208.80
|
| Rate for Payer: Aetna Government |
$208.80
|
| Rate for Payer: Brighton Health Commercial |
$433.28
|
| 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 |
$288.85
|
| Rate for Payer: Group Health Inc Medicare |
$202.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.85
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ARTER. BELOW DIAPH. 1ST
|
Facility
|
OP
|
$3,839.45
|
|
|
Service Code
|
HCPCS 36245 TC
|
| Hospital Charge Code |
41542026
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,113.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,483.68
|
| Rate for Payer: Aetna Government |
$1,483.68
|
| Rate for Payer: Brighton Health Commercial |
$2,879.59
|
| 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 |
$1,919.72
|
| Rate for Payer: Group Health Inc Medicare |
$1,343.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,919.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,919.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ARTER. BELOW DIAPH. 2N
|
Facility
|
OP
|
$3,759.98
|
|
|
Service Code
|
HCPCS 36246 TC
|
| Hospital Charge Code |
41542052
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$967.26 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$967.26
|
| Rate for Payer: Aetna Government |
$967.26
|
| Rate for Payer: Brighton Health Commercial |
$2,819.98
|
| 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 |
$1,879.99
|
| Rate for Payer: Group Health Inc Medicare |
$1,315.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,879.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,879.99
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ARTER. BELOW DIAPH. >3
|
Facility
|
OP
|
$494.03
|
|
|
Service Code
|
HCPCS 36248 TC
|
| Hospital Charge Code |
41542683
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$164.82
|
| Rate for Payer: Aetna Government |
$164.82
|
| Rate for Payer: Brighton Health Commercial |
$370.52
|
| 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 |
$247.02
|
| Rate for Payer: Group Health Inc Medicare |
$172.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.02
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ARTER. BELOW DIAPH. 3R
|
Facility
|
OP
|
$5,942.45
|
|
|
Service Code
|
HCPCS 36247 TC
|
| Hospital Charge Code |
41542682
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,113.00 |
| Max. Negotiated Rate |
$4,456.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,710.29
|
| Rate for Payer: Aetna Government |
$1,710.29
|
| Rate for Payer: Brighton Health Commercial |
$4,456.84
|
| 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 |
$2,971.22
|
| Rate for Payer: Group Health Inc Medicare |
$2,079.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,971.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,971.22
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ARTHROCENTESIS LARGE JOINT
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
30302002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$393.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
SP ARTHROCENTESIS LARGE JOINT
|
Facility
|
IP
|
$1,229.75
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
30102473
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
SP ARTHROCENTESIS LARGE JOINT
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 20610 TC
|
| Hospital Charge Code |
41548512
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
SP ARTHROCENTESIS LARGE JOINT
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
30302002
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
SP ARTHROCENTESIS LARGE JOINT
|
Facility
|
OP
|
$1,229.75
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
30102473
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$342.51
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$614.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
SP ARTHROCENTESIS LARGE JOINT
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 20610 TC
|
| Hospital Charge Code |
41548512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$589.50
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: EmblemHealth Commercial |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| Rate for Payer: Group Health Inc Commercial |
$342.51
|
| Rate for Payer: Group Health Inc Medicare |
$342.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
SP ARTHROCENTESIS MEDIUM JOINT
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 20605 TC
|
| Hospital Charge Code |
41548511
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$342.51
|
|
|
SP ARTHROCENTESIS MEDIUM JOINT
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 20605 TC
|
| Hospital Charge Code |
41548511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$239.76
|
| Rate for Payer: Brighton Health Commercial |
$589.50
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: EmblemHealth Commercial |
$342.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| Rate for Payer: Group Health Inc Commercial |
$342.51
|
| Rate for Payer: Group Health Inc Medicare |
$342.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: Humana Medicare |
$349.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
SP ART OCCLUSIVE DEVICE PLCMT
|
Facility
|
OP
|
$776.34
|
|
|
Service Code
|
HCPCS G0269 TC
|
| Hospital Charge Code |
41561953
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$621.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$426.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.12
|
| Rate for Payer: Aetna Government |
$14.12
|
| Rate for Payer: Brighton Health Commercial |
$582.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$621.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$527.91
|
| Rate for Payer: Group Health Inc Commercial |
$388.17
|
| Rate for Payer: Group Health Inc Medicare |
$271.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$388.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$388.17
|
|
|
SP ASPIRATION BREAST CYST
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 19000 TC
|
| Hospital Charge Code |
41549614
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$813.63
|
|
