|
SP CHANGE INT/EXT N-U
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 50387 TC
|
| Hospital Charge Code |
41548032
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
SP CHANGE INT/EXT N-U
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 50387 TC
|
| Hospital Charge Code |
41548032
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$4,024.18
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$2,355.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
SP CHANGE URETEROSTOMY CATH
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 50688 TC
|
| Hospital Charge Code |
41547639
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
SP CHANGE URETEROSTOMY CATH
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 50688 TC
|
| Hospital Charge Code |
41547639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$4,024.18
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$2,355.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
SP CHANGE URTRLSTNT 1/EA/CONDUIT
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 50688 TC
|
| Hospital Charge Code |
41548034
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$4,024.18
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$2,355.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
SP CHANGE URTRLSTNT 1/EA/CONDUIT
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 50688 TC
|
| Hospital Charge Code |
41548034
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
SP CHEMOTHERAPY IA ADMINISRATION
|
Facility
|
OP
|
$937.70
|
|
|
Service Code
|
HCPCS 96420 TC
|
| Hospital Charge Code |
41547638
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$274.15 |
| Max. Negotiated Rate |
$703.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$391.64
|
| Rate for Payer: Aetna Government |
$391.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$274.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$274.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$274.15
|
| Rate for Payer: Brighton Health Commercial |
$703.28
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Cash Price |
$391.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$644.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$547.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$391.64
|
| Rate for Payer: EmblemHealth Commercial |
$391.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$391.64
|
| Rate for Payer: Group Health Inc Medicare |
$391.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$468.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.89
|
| Rate for Payer: Healthfirst QHP |
$391.64
|
| Rate for Payer: Humana Medicare |
$399.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.64
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$391.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$313.31
|
| Rate for Payer: Wellcare Medicare |
$372.06
|
|
|
SP CHEMOTHERAPY IA ADMINISRATION
|
Facility
|
IP
|
$937.70
|
|
|
Service Code
|
HCPCS 96420 TC
|
| Hospital Charge Code |
41547638
|
|
Hospital Revenue Code
|
331
|
| Rate for Payer: Cash Price |
$391.64
|
|
|
SP CHEST TUBE ABSCESS HEMOTHORAX
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 32551 TC
|
| Hospital Charge Code |
41561811
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
SP CHEST TUBE ABSCESS HEMOTHORAX
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 32551 TC
|
| Hospital Charge Code |
41561811
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,705.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,852.05
|
| Rate for Payer: Aetna Government |
$1,852.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,296.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,296.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,296.44
|
| Rate for Payer: Brighton Health Commercial |
$3,705.21
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$1,852.05
|
| Rate for Payer: EmblemHealth Commercial |
$1,852.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,574.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,648.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,852.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,648.32
|
| Rate for Payer: Group Health Inc Commercial |
$1,852.05
|
| Rate for Payer: Group Health Inc Medicare |
$1,852.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,574.24
|
| Rate for Payer: Healthfirst QHP |
$1,852.05
|
| Rate for Payer: Humana Medicare |
$1,889.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,852.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,481.64
|
| Rate for Payer: Wellcare Medicare |
$1,759.45
|
|
|
SP CHOLEDOCHAL STENT PLACE.
|
Facility
|
OP
|
$2,807.50
|
|
|
Service Code
|
HCPCS 47801 TC
|
| Hospital Charge Code |
41547452
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$982.62 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,544.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,149.13
|
| Rate for Payer: Aetna Government |
$1,149.13
|
| Rate for Payer: Brighton Health Commercial |
$2,105.62
|
| 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 |
$1,403.75
|
| Rate for Payer: Group Health Inc Medicare |
$982.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,403.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,403.75
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP COMMON CARTID ARTY CATHER UNI
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36223 TC
|
| Hospital Charge Code |
41103009
|
|
Hospital Revenue Code
|
329
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
SP COMMON CARTID ARTY CATHER UNI
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 36223 TC
|
| Hospital Charge Code |
41103009
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$6,960.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,448.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,448.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,448.46
|
| Rate for Payer: Brighton Health Commercial |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$4,448.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$5,719.45
|
| Rate for Payer: Group Health Inc Medicare |
$5,719.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Humana Medicare |
$6,482.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
SP COMMON FEMORAL, INSILATERAL
|
Facility
|
OP
|
$1,475.15
|
|
|
Service Code
|
HCPCS 36140 TC
|
| Hospital Charge Code |
41542826
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$475.11
|
| Rate for Payer: Aetna Government |
$475.11
|
| Rate for Payer: Brighton Health Commercial |
$1,106.36
|
| 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 |
$737.58
|
| Rate for Payer: Group Health Inc Medicare |
$516.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$737.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$737.58
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP COMPLETE PENILE
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93980 TC
|
| Hospital Charge Code |
41201176
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
SP COMPLETE PENILE
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93980 TC
|
| Hospital Charge Code |
41201176
|
|
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 COMP REN/MESE/POR ABD
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93975 TC
|
| Hospital Charge Code |
41201172
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
SP COMP REN/MESE/POR ABD
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93975 TC
|
| Hospital Charge Code |
41201172
|
|
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 CONSC. SEDAT. AGE<5 1ST 30 MIN
|
Facility
|
OP
|
$84.10
|
|
|
Service Code
|
HCPCS 99151 TC
|
| Hospital Charge Code |
41548613
|
|
Hospital Revenue Code
|
372
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$68.85
|
| Rate for Payer: Aetna Government |
$68.85
|
| Rate for Payer: Brighton Health Commercial |
$63.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.19
|
| Rate for Payer: Group Health Inc Commercial |
$42.05
|
| Rate for Payer: Group Health Inc Medicare |
$29.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.05
|
|
|
SP CONSC. SEDAT. AGE<5 1ST 30 MIN
|
Facility
|
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 99143
|
| Hospital Charge Code |
30102476
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,455.04 |
| Max. Negotiated Rate |
$3,325.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Government |
$2,078.62
|
| Rate for Payer: Brighton Health Commercial |
$3,117.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,325.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,826.93
|
| Rate for Payer: Group Health Inc Commercial |
$2,078.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,078.62
|
|
|
SP CONSC. SEDAT. AGE>5 1ST 30 MIN
|
Facility
|
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 99144
|
| Hospital Charge Code |
30102472
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$277.49 |
| Max. Negotiated Rate |
$634.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$436.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$396.42
|
| Rate for Payer: Aetna Government |
$396.42
|
| Rate for Payer: Brighton Health Commercial |
$594.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$634.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$539.12
|
| Rate for Payer: Group Health Inc Commercial |
$396.42
|
| Rate for Payer: Group Health Inc Medicare |
$277.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.42
|
|
|
SP CONSC. SEDAT. AGE>5 1ST 30 MIN
|
Facility
|
OP
|
$84.10
|
|
|
Service Code
|
HCPCS 99152 TC
|
| Hospital Charge Code |
41548612
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$67.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.88
|
| Rate for Payer: Aetna Government |
$45.88
|
| Rate for Payer: Brighton Health Commercial |
$63.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.19
|
| Rate for Payer: Group Health Inc Commercial |
$42.05
|
| Rate for Payer: Group Health Inc Medicare |
$29.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.05
|
|
|
SP CONSC. SEDAT. EACH ADD'L 15MIN
|
Facility
|
OP
|
$42.05
|
|
|
Service Code
|
HCPCS 99153 TC
|
| Hospital Charge Code |
41548614
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$33.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.07
|
| Rate for Payer: Aetna Government |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$31.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.59
|
| Rate for Payer: Group Health Inc Commercial |
$21.02
|
| Rate for Payer: Group Health Inc Medicare |
$14.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.02
|
|
|
SP CONSC. SEDAT. EACH ADD'L 15MIN
|
Facility
|
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 99145
|
| Hospital Charge Code |
30102477
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,455.04 |
| Max. Negotiated Rate |
$3,325.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Government |
$2,078.62
|
| Rate for Payer: Brighton Health Commercial |
$3,117.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,325.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,826.93
|
| Rate for Payer: Group Health Inc Commercial |
$2,078.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,078.62
|
|
|
SP CONTRAST INJ CK VEN ACCESS
|
Facility
|
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 36598 TC
|
| Hospital Charge Code |
41548029
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.51 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$173.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$173.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$173.51
|
| Rate for Payer: Brighton Health Commercial |
$417.38
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| 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 |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$247.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| Rate for Payer: Group Health Inc Commercial |
$247.87
|
| Rate for Payer: Group Health Inc Medicare |
$247.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Humana Medicare |
$252.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
