|
SP PLMT NEPHROURETERAL CATH
|
Facility
|
IP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 50433 TC
|
| Hospital Charge Code |
41547456
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,031.47
|
|
|
SP PLMT NEPHROURETERAL CATH
|
Facility
|
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 50433 TC
|
| Hospital Charge Code |
41547456
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,856.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,822.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,822.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,822.03
|
| Rate for Payer: Brighton Health Commercial |
$6,856.80
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$4,031.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Humana Medicare |
$4,112.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
SP POPLI-TIBIO-PERO ART BY LEG IN
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 34203 TC
|
| Hospital Charge Code |
41547718
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
SP POPLI-TIBIO-PERO ART BY LEG IN
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 34203 TC
|
| Hospital Charge Code |
41547718
|
|
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 PORTAL VEIN (ANY ACCESS)
|
Facility
|
OP
|
$1,249.78
|
|
|
Service Code
|
HCPCS 36481 TC
|
| Hospital Charge Code |
41547446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.42 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,195.76
|
| Rate for Payer: Aetna Government |
$2,195.76
|
| Rate for Payer: Brighton Health Commercial |
$937.34
|
| 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 |
$624.89
|
| Rate for Payer: Group Health Inc Medicare |
$437.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$624.89
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP PORTAL VENOGRAM, W/PRESSURES
|
Facility
|
OP
|
$1,249.78
|
|
|
Service Code
|
HCPCS 36481 TC
|
| Hospital Charge Code |
41547726
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$437.42 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,195.76
|
| Rate for Payer: Aetna Government |
$2,195.76
|
| Rate for Payer: Brighton Health Commercial |
$937.34
|
| 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 |
$624.89
|
| Rate for Payer: Group Health Inc Medicare |
$437.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$624.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$624.89
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP PRCRD DRG 0-5YR OR W/ANOMLY
|
Facility
|
OP
|
$819.96
|
|
|
Service Code
|
HCPCS 33018 TC
|
| Hospital Charge Code |
41546552
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$286.99 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$450.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Government |
$311.25
|
| Rate for Payer: Brighton Health Commercial |
$614.97
|
| 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 |
$409.98
|
| Rate for Payer: Group Health Inc Medicare |
$286.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$409.98
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP PRCRD DRG 6YR+ W/O CGENITA CAR
|
Facility
|
OP
|
$745.42
|
|
|
Service Code
|
HCPCS 33017 TC
|
| Hospital Charge Code |
41546551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$260.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$409.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.62
|
| Rate for Payer: Aetna Government |
$275.62
|
| Rate for Payer: Brighton Health Commercial |
$559.06
|
| 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 |
$372.71
|
| Rate for Payer: Group Health Inc Medicare |
$260.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$372.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$372.71
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP PRESSURE GRADIENTS
|
Facility
|
OP
|
$174.04
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
30102470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.54
|
| Rate for Payer: Aetna Government |
$53.54
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| 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: EmblemHealth Commercial |
$525.00
|
| 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 |
$87.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
SP PRESSURE GRADIENTS
|
Facility
|
OP
|
$174.04
|
|
|
Service Code
|
HCPCS 36620 TC
|
| Hospital Charge Code |
41542810
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.54
|
| Rate for Payer: Aetna Government |
$53.54
|
| Rate for Payer: Brighton Health Commercial |
$130.53
|
| 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 |
$87.02
|
| Rate for Payer: Group Health Inc Medicare |
$60.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.02
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP PROSTATE PERCUTANEOUS
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 55700 TC
|
| Hospital Charge Code |
41542804
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
SP PROSTATE PERCUTANEOUS
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 55700 TC
|
| Hospital Charge Code |
41542804
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 PSEUDOCYST DRAINAGE GASTRIC
|
Facility
|
OP
|
$5,409.22
|
|
|
Service Code
|
HCPCS 48520 TC
|
| Hospital Charge Code |
41561812
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,299.10 |
| Max. Negotiated Rate |
$4,056.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,975.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,299.10
|
| Rate for Payer: Aetna Government |
$1,299.10
|
| Rate for Payer: Brighton Health Commercial |
$4,056.92
|
| 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 |
$2,704.61
|
| Rate for Payer: Group Health Inc Medicare |
$1,893.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,704.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,704.61
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP PSEUDONRYSM REPAIR THROMB. INJ
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36002 TC
|
| Hospital Charge Code |
41549616
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$726.47
|
|
|
SP PSEUDONRYSM REPAIR THROMB. INJ
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 36002 TC
|
| Hospital Charge Code |
41549616
|
|
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 |
$726.47
|
| Rate for Payer: Aetna Government |
$726.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.53
|
| Rate for Payer: Brighton Health Commercial |
$1,432.24
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$726.47
|
| Rate for Payer: EmblemHealth Commercial |
$726.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.56
|
| Rate for Payer: Group Health Inc Commercial |
$726.47
|
| Rate for Payer: Group Health Inc Medicare |
$726.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.50
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: Humana Medicare |
$741.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.18
|
| Rate for Payer: Wellcare Medicare |
$690.15
|
|
|
SP PTA ILIAC ARTERY
|
Facility
|
IP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37220 TC
|
| Hospital Charge Code |
41542753
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,609.72
|
|
|
SP PTA ILIAC ARTERY
|
Facility
|
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37220 TC
|
| Hospital Charge Code |
41542753
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$11,253.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,609.72
|
| Rate for Payer: Aetna Government |
$6,609.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,626.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,626.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,626.80
|
| Rate for Payer: Brighton Health Commercial |
$11,253.11
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Cash Price |
$6,609.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,609.72
|
| 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 |
$6,609.72
|
| Rate for Payer: EmblemHealth Commercial |
$6,609.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,618.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,882.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,609.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,882.65
|
| Rate for Payer: Group Health Inc Commercial |
$6,609.72
|
| Rate for Payer: Group Health Inc Medicare |
$6,609.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,609.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,618.26
|
| Rate for Payer: Healthfirst QHP |
$6,609.72
|
| Rate for Payer: Humana Medicare |
$6,741.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,609.72
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,609.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,609.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,287.78
|
| Rate for Payer: Wellcare Medicare |
$6,279.23
|
|
|
SP PULMON. ART. UNI. 1ST-
|
Facility
|
OP
|
$2,545.83
|
|
|
Service Code
|
HCPCS 36014 TC
|
| Hospital Charge Code |
41542684
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$875.05
|
| Rate for Payer: Aetna Government |
$875.05
|
| Rate for Payer: Brighton Health Commercial |
$1,909.37
|
| 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 |
$1,272.92
|
| Rate for Payer: Group Health Inc Medicare |
$891.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,272.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,272.92
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP PULMON. ART. UNI. >2ND
|
Facility
|
OP
|
$2,787.43
|
|
|
Service Code
|
HCPCS 36015 TC
|
| Hospital Charge Code |
41542686
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$936.18
|
| Rate for Payer: Aetna Government |
$936.18
|
| Rate for Payer: Brighton Health Commercial |
$2,090.57
|
| 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 |
$1,393.72
|
| Rate for Payer: Group Health Inc Medicare |
$975.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,393.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,393.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP RADIOFREQUENCY ABLATION BONE
|
Facility
|
OP
|
$17,690.84
|
|
|
Service Code
|
HCPCS 20982 TC
|
| Hospital Charge Code |
41548533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$15,524.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,219.83
|
| Rate for Payer: Aetna Government |
$15,219.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10,653.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10,653.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10,653.88
|
| Rate for Payer: Brighton Health Commercial |
$13,268.13
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Cash Price |
$15,219.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15,219.83
|
| 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 |
$15,219.83
|
| Rate for Payer: EmblemHealth Commercial |
$15,219.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12,936.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13,545.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,219.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13,545.65
|
| Rate for Payer: Group Health Inc Commercial |
$15,219.83
|
| Rate for Payer: Group Health Inc Medicare |
$15,219.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,845.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,219.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,936.86
|
| Rate for Payer: Healthfirst QHP |
$15,219.83
|
| Rate for Payer: Humana Medicare |
$15,524.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,219.83
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,219.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,219.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,175.86
|
| Rate for Payer: Wellcare Medicare |
$14,458.84
|
|
|
SP RADIOFREQUENCY ABLATION BONE
|
Facility
|
IP
|
$17,690.84
|
|
|
Service Code
|
HCPCS 20982 TC
|
| Hospital Charge Code |
41548533
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$15,219.83
|
|
|
SP RADIOFREQUENCY ABLATION LIVER
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47382 TC
|
| Hospital Charge Code |
41549617
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
|
SP RADIOFREQUENCY ABLATION LIVER
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47382 TC
|
| Hospital Charge Code |
41549617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$10,980.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,670.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,670.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,670.77
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$6,672.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Humana Medicare |
$6,805.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
SP RADIOLOGICAL SUPERVISION
|
Facility
|
OP
|
$3,200.13
|
|
|
Service Code
|
HCPCS 75894 TC
|
| Hospital Charge Code |
41543350
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$718.34 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,760.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$718.34
|
| Rate for Payer: Aetna Government |
$718.34
|
| Rate for Payer: Brighton Health Commercial |
$2,400.10
|
| 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 |
$1,600.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,120.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,600.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,600.06
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC
|
Facility
|
IP
|
$28,514.21
|
|
|
Service Code
|
MSDRG 537
|
| Min. Negotiated Rate |
$8,292.03 |
| Max. Negotiated Rate |
$28,514.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,258.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,737.61
|
| Rate for Payer: Aetna Government |
$20,737.61
|
| Rate for Payer: Brighton Health Commercial |
$14,021.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,152.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,699.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,780.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,700.73
|
| Rate for Payer: EmblemHealth Commercial |
$8,292.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,737.61
|
| Rate for Payer: Group Health Inc Commercial |
$20,737.61
|
| Rate for Payer: Group Health Inc Medicare |
$20,737.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,737.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,642.99
|
| Rate for Payer: Humana Medicare |
$28,514.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,737.61
|
| Rate for Payer: United Healthcare Commercial |
$19,230.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,737.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,737.61
|
| Rate for Payer: Wellcare Medicare |
$19,700.73
|
|
