|
SP EMBOLI BLEED
|
Facility
|
IP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37244 TC
|
| Hospital Charge Code |
41104009
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,721.98
|
|
|
SP EMBOLI BLEED
|
Facility
|
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37244 TC
|
| Hospital Charge Code |
41104009
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$22,507.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 EMBOLI ORGAN
|
Facility
|
OP
|
$30,948.00
|
|
|
Service Code
|
HCPCS 37243 TC
|
| Hospital Charge Code |
41104007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$23,211.00 |
| 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 |
$23,211.00
|
| 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 |
$15,474.00
|
| 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 EMBOLI ORGAN
|
Facility
|
IP
|
$30,948.00
|
|
|
Service Code
|
HCPCS 37243 TC
|
| Hospital Charge Code |
41104007
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,721.98
|
|
|
SP EMBOLIZATION (NEURO)
|
Facility
|
OP
|
$3,193.63
|
|
|
Service Code
|
HCPCS 61624 TC
|
| Hospital Charge Code |
41542743
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,117.77 |
| Max. Negotiated Rate |
$3,190.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,756.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,389.31
|
| Rate for Payer: Aetna Government |
$1,389.31
|
| Rate for Payer: Brighton Health Commercial |
$2,395.22
|
| 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 |
$1,596.82
|
| Rate for Payer: Group Health Inc Medicare |
$1,117.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,596.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,596.82
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
|
|
SP EMBOLIZ. EXTRACRAN. HEAD &NECK
|
Facility
|
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 61626 TC
|
| Hospital Charge Code |
41549742
|
|
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 EMBOLIZ. EXTRACRAN. HEAD &NECK
|
Facility
|
IP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 61626 TC
|
| Hospital Charge Code |
41549742
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,721.98
|
|
|
SP EMB/THROMB-AXILL,BRACH-ARMINCI
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 34101 TC
|
| Hospital Charge Code |
41547715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$10,440.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| 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 |
$10,440.52
|
| 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 |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: Group Health Inc Medicare |
$6,354.94
|
| 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 Commercial |
$2,546.00
|
| 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 EMB/THROMB-AXILL,BRACH-ARMINCI
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 34101 TC
|
| Hospital Charge Code |
41547715
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
SP EMB/THROM,FEMOR,AORT-IL ART,LE
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 34201 TC
|
| Hospital Charge Code |
41547717
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$10,440.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| 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 |
$10,440.52
|
| 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 |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: Group Health Inc Medicare |
$6,354.94
|
| 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 Commercial |
$2,546.00
|
| 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 EMB/THROM,FEMOR,AORT-IL ART,LE
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 34201 TC
|
| Hospital Charge Code |
41547717
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
SP EMB/THROM-REN,CEL,AORILL,ABD I
|
Facility
|
OP
|
$2,061.05
|
|
|
Service Code
|
HCPCS 34151 TC
|
| Hospital Charge Code |
41547716
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$721.37 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,133.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,592.01
|
| Rate for Payer: Aetna Government |
$1,592.01
|
| Rate for Payer: Brighton Health Commercial |
$1,545.79
|
| 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 |
$1,030.52
|
| Rate for Payer: Group Health Inc Medicare |
$721.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,030.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,030.52
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP ENDOLUMINAL BX URTR RNL PLVS
|
Facility
|
OP
|
$2,804.37
|
|
|
Service Code
|
HCPCS 50606
|
| Hospital Charge Code |
41542909
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.44
|
| Rate for Payer: Aetna Government |
$192.44
|
| Rate for Payer: Brighton Health Commercial |
$2,103.28
|
| 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 |
$1,402.18
|
| Rate for Payer: Group Health Inc Medicare |
$981.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,402.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,402.18
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ENDOVENOUS ABLAT THERAPY
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
41200615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
SP ENDOVENOUS ABLAT THERAPY
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36478
|
| Hospital Charge Code |
41200615
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
SP ENDOVENOUS LASER ABLATION, 1ST
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36478 TC
|
| Hospital Charge Code |
41561844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
SP ENDOVENOUS LASER ABLATION, 1ST
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36478 TC
|
| Hospital Charge Code |
41561844
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
SP ENDOVENOUS LASER ABLATION ADD
|
Facility
|
OP
|
$6,231.85
|
|
|
Service Code
|
HCPCS 36479 TC
|
| Hospital Charge Code |
41561845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$4,673.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$313.95
|
| Rate for Payer: Aetna Government |
$313.95
|
| Rate for Payer: Brighton Health Commercial |
$4,673.89
|
| 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 |
$3,115.92
|
| Rate for Payer: Group Health Inc Medicare |
$2,181.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,115.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,115.92
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ENDOVENOUS MCHNCHEM 1ST VEIN
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36473 TC
|
| Hospital Charge Code |
41563235
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
SP ENDOVENOUS MCHNCHEM 1ST VEIN
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 36473 TC
|
| Hospital Charge Code |
41563235
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
SP ENDOVENOUS MCHNCHEM ADDL
|
Facility
|
OP
|
$2,077.28
|
|
|
Service Code
|
HCPCS 36474 TC
|
| Hospital Charge Code |
41563236
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$295.66 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.66
|
| Rate for Payer: Aetna Government |
$295.66
|
| Rate for Payer: Brighton Health Commercial |
$1,557.96
|
| 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 |
$1,038.64
|
| Rate for Payer: Group Health Inc Medicare |
$727.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.64
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ENTEROCLYSIS
|
Facility
|
OP
|
$494.71
|
|
|
Service Code
|
HCPCS 44015 TC
|
| Hospital Charge Code |
41542709
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$272.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.87
|
| Rate for Payer: Aetna Government |
$169.87
|
| Rate for Payer: Brighton Health Commercial |
$371.03
|
| 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 |
$247.36
|
| Rate for Payer: Group Health Inc Medicare |
$173.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.36
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP E.R.C.P. W/STENT
|
Facility
|
IP
|
$14,479.95
|
|
|
Service Code
|
HCPCS 43274 TC
|
| Hospital Charge Code |
41546008
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,590.73
|
|
|
SP E.R.C.P. W/STENT
|
Facility
|
OP
|
$14,479.95
|
|
|
Service Code
|
HCPCS 43274 TC
|
| Hospital Charge Code |
41546008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$10,859.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,590.73
|
| Rate for Payer: Aetna Government |
$6,590.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,613.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,613.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,613.51
|
| Rate for Payer: Brighton Health Commercial |
$10,859.96
|
| Rate for Payer: Cash Price |
$6,590.73
|
| Rate for Payer: Cash Price |
$6,590.73
|
| Rate for Payer: Cash Price |
$6,590.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,590.73
|
| 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 |
$6,590.73
|
| Rate for Payer: EmblemHealth Commercial |
$6,590.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,602.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,865.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,590.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,865.75
|
| Rate for Payer: Group Health Inc Commercial |
$6,590.73
|
| Rate for Payer: Group Health Inc Medicare |
$6,590.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,239.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,590.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,602.12
|
| Rate for Payer: Healthfirst QHP |
$6,590.73
|
| Rate for Payer: Humana Medicare |
$6,722.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,590.73
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,590.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,590.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,272.58
|
| Rate for Payer: Wellcare Medicare |
$6,261.19
|
|
|
SP ESOPHAGUS DILATION
|
Facility
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43453 TC
|
| Hospital Charge Code |
41547677
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
