|
SP PERC BIL DRAIN (EXTER)
|
Facility
|
IP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47533 TC
|
| Hospital Charge Code |
41542720
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,000.83
|
|
|
SP PERC BIL DRAIN (EXTER)
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47533 TC
|
| Hospital Charge Code |
41542720
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$7,063.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,000.83
|
| Rate for Payer: Aetna Government |
$4,000.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,800.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,800.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,800.58
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,000.83
|
| 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 |
$4,000.83
|
| Rate for Payer: EmblemHealth Commercial |
$4,000.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,400.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,560.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,000.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,560.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,000.83
|
| Rate for Payer: Group Health Inc Medicare |
$4,000.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,000.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,400.71
|
| Rate for Payer: Healthfirst QHP |
$4,000.83
|
| Rate for Payer: Humana Medicare |
$4,080.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,000.83
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,000.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,000.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,200.66
|
| Rate for Payer: Wellcare Medicare |
$3,800.79
|
|
|
SP PERC BIL DRAIN (INT/EXT)
|
Facility
|
OP
|
$1,714.43
|
|
| Hospital Charge Code |
41542722
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.05 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$942.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$857.22
|
| Rate for Payer: Aetna Government |
$857.22
|
| Rate for Payer: Brighton Health Commercial |
$1,285.82
|
| 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 |
$857.22
|
| Rate for Payer: Group Health Inc Medicare |
$600.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$857.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$857.22
|
|
|
SP PERC. CHOLECYSTOTOMY
|
Facility
|
IP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47490 TC
|
| Hospital Charge Code |
41547451
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,000.83
|
|
|
SP PERC. CHOLECYSTOTOMY
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47490 TC
|
| Hospital Charge Code |
41547451
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$7,063.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,000.83
|
| Rate for Payer: Aetna Government |
$4,000.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,800.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,800.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,800.58
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,000.83
|
| 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 |
$4,000.83
|
| Rate for Payer: EmblemHealth Commercial |
$4,000.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,400.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,560.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,000.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,560.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,000.83
|
| Rate for Payer: Group Health Inc Medicare |
$4,000.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,000.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,400.71
|
| Rate for Payer: Healthfirst QHP |
$4,000.83
|
| Rate for Payer: Humana Medicare |
$4,080.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,000.83
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,000.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,000.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,200.66
|
| Rate for Payer: Wellcare Medicare |
$3,800.79
|
|
|
SP PERC DILA BIL STRICT W/O STENT
|
Facility
|
IP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47555 TC
|
| Hospital Charge Code |
41547669
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,000.83
|
|
|
SP PERC DILA BIL STRICT W/O STENT
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47555 TC
|
| Hospital Charge Code |
41547669
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$7,063.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,000.83
|
| Rate for Payer: Aetna Government |
$4,000.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,800.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,800.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,800.58
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,000.83
|
| 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 |
$4,000.83
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,400.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,560.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,000.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,560.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,000.83
|
| Rate for Payer: Group Health Inc Medicare |
$4,000.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,000.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,400.71
|
| Rate for Payer: Healthfirst QHP |
$4,000.83
|
| Rate for Payer: Humana Medicare |
$4,080.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,000.83
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,000.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,000.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,200.66
|
| Rate for Payer: Wellcare Medicare |
$3,800.79
|
|
|
SP PERC DILA BIL STRICT W STENT
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47556 TC
|
| Hospital Charge Code |
41547671
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$12,141.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11,903.87
|
| Rate for Payer: Aetna Government |
$11,903.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,332.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,332.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,332.71
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11,903.87
|
| 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 |
$11,903.87
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,118.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,594.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,903.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,594.44
|
| Rate for Payer: Group Health Inc Commercial |
$11,903.87
|
| Rate for Payer: Group Health Inc Medicare |
$11,903.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,903.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,118.29
|
| Rate for Payer: Healthfirst QHP |
$11,903.87
|
| Rate for Payer: Humana Medicare |
$12,141.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11,903.87
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,903.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11,903.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,523.10
|
| Rate for Payer: Wellcare Medicare |
$11,308.68
|
|
|
SP PERC DILA BIL STRICT W STENT
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47556 TC
|
| Hospital Charge Code |
41547671
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$11,903.87
|
|
|
SP PERC DIL BIL W/O STENT
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47555 TC
|
| Hospital Charge Code |
41542716
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$7,063.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,000.83
|
| Rate for Payer: Aetna Government |
$4,000.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,800.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,800.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,800.58
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,000.83
|
| 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 |
$4,000.83
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,400.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,560.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,000.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,560.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,000.83
|
| Rate for Payer: Group Health Inc Medicare |
$4,000.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,000.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,400.71
|
| Rate for Payer: Healthfirst QHP |
$4,000.83
|
| Rate for Payer: Humana Medicare |
$4,080.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,000.83
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,000.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,000.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,200.66
|
| Rate for Payer: Wellcare Medicare |
$3,800.79
|
|
|
SP PERC DIL BIL W/O STENT
|
Facility
|
IP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47555 TC
|
| Hospital Charge Code |
41542716
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,000.83
|
|
|
SP PERC DIL BIL W/ STENT
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47556 TC
|
| Hospital Charge Code |
41542718
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$11,903.87
|
|
|
SP PERC DIL BIL W/ STENT
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47556 TC
|
| Hospital Charge Code |
41542718
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$12,141.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11,903.87
|
| Rate for Payer: Aetna Government |
$11,903.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,332.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,332.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,332.71
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11,903.87
|
| 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 |
$11,903.87
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,118.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,594.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,903.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,594.44
|
| Rate for Payer: Group Health Inc Commercial |
$11,903.87
|
| Rate for Payer: Group Health Inc Medicare |
$11,903.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,903.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,118.29
|
| Rate for Payer: Healthfirst QHP |
$11,903.87
|
| Rate for Payer: Humana Medicare |
$12,141.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11,903.87
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,903.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11,903.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,523.10
|
| Rate for Payer: Wellcare Medicare |
$11,308.68
|
|
|
SP PERC OCCLUSION FEMORAL VEIN
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37650 TC
|
| Hospital Charge Code |
41547691
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 PERC OCCLUSION FEMORAL VEIN
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37650 TC
|
| Hospital Charge Code |
41547691
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
SP PERC OCCLUSION ILLIAC VEIN
|
Facility
|
OP
|
$3,327.13
|
|
|
Service Code
|
HCPCS 37660 TC
|
| Hospital Charge Code |
41547692
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,164.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,829.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,312.95
|
| Rate for Payer: Aetna Government |
$1,312.95
|
| Rate for Payer: Brighton Health Commercial |
$2,495.35
|
| 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 |
$1,663.56
|
| Rate for Payer: Group Health Inc Medicare |
$1,164.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,663.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,663.56
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP PERC PLACE DUOD/JEJ TUBE
|
Facility
|
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 49441 TC
|
| Hospital Charge Code |
41561820
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,537.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,540.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,540.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,540.32
|
| Rate for Payer: Brighton Health Commercial |
$3,537.74
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$2,200.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Humana Medicare |
$2,244.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
SP PERC PLACE DUOD/JEJ TUBE
|
Facility
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 49441 TC
|
| Hospital Charge Code |
41561820
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
|
SP PERC PLACE IVC FILTER
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37191 TC
|
| Hospital Charge Code |
41542778
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$10,440.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| 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 PERC PLACE IVC FILTER
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37191 TC
|
| Hospital Charge Code |
41542778
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
SP PERC. RENAL CYST ASPIR.
|
Facility
|
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 50390 TC
|
| Hospital Charge Code |
41547459
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Brighton Health Commercial |
$1,385.68
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
SP PERC. RENAL CYST ASPIR.
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 50390 TC
|
| Hospital Charge Code |
41547459
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$813.63
|
|
|
SP PERC TRANSCATH RETR.
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37197 TC
|
| Hospital Charge Code |
41542747
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
SP PERC TRANSCATH RETR.
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37197 TC
|
| Hospital Charge Code |
41542747
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 PERC TRANSHEPATIC CHOLANGIOGR
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47532 TC
|
| Hospital Charge Code |
41547682
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$7,063.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,000.83
|
| Rate for Payer: Aetna Government |
$4,000.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,800.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,800.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,800.58
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,000.83
|
| 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 |
$4,000.83
|
| Rate for Payer: EmblemHealth Commercial |
$4,000.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,400.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,560.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,000.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,560.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,000.83
|
| Rate for Payer: Group Health Inc Medicare |
$4,000.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,000.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,400.71
|
| Rate for Payer: Healthfirst QHP |
$4,000.83
|
| Rate for Payer: Humana Medicare |
$4,080.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,000.83
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,000.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,000.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,200.66
|
| Rate for Payer: Wellcare Medicare |
$3,800.79
|
|
