|
SP THROMBOLYTIC ARTERIAL THERAPY
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37211 TC
|
| Hospital Charge Code |
41543300
|
|
Hospital Revenue Code
|
329
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
SP THROMBOLYTIC ARTERIAL THERAPY
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37211 TC
|
| Hospital Charge Code |
41543300
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$1,888.00 |
| Max. Negotiated Rate |
$6,960.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 THROMBOLYTIC VENOUS THERAPY
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37212 TC
|
| Hospital Charge Code |
41543301
|
|
Hospital Revenue Code
|
329
|
| Min. Negotiated Rate |
$1,888.00 |
| Max. Negotiated Rate |
$4,196.76 |
| 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 |
$3,686.08
|
| 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 |
$2,580.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,133.17
|
| 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 |
$3,317.47
|
| Rate for Payer: Group Health Inc Medicare |
$3,317.47
|
| 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 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 THROMBOLYTIC VENOUS THERAPY
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37212 TC
|
| Hospital Charge Code |
41543301
|
|
Hospital Revenue Code
|
329
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
SP THYROID PERCUTANEOUS
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 60100 TC
|
| Hospital Charge Code |
41542805
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$813.63
|
|
|
SP THYROID PERCUTANEOUS
|
Facility
|
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 60100 TC
|
| Hospital Charge Code |
41542805
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 TIB/PER REVASC STENT & ATHER
|
Facility
|
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
41101443
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$36,208.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14,194.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14,194.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14,194.60
|
| Rate for Payer: Brighton Health Commercial |
$36,208.64
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$20,278.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Humana Medicare |
$20,683.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
SP TIB/PER REVASC STENT & ATHER
|
Facility
|
IP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 37231
|
| Hospital Charge Code |
41101443
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$20,278.00
|
|
|
SP TIB/PER REVASC W/ATHER UNI
|
Facility
|
IP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 37229
|
| Hospital Charge Code |
41546562
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$20,278.00
|
|
|
SP TIB/PER REVASC W/ATHER UNI
|
Facility
|
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 37229
|
| Hospital Charge Code |
41546562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$36,208.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14,194.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14,194.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14,194.60
|
| Rate for Payer: Brighton Health Commercial |
$36,208.64
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$20,278.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Humana Medicare |
$20,683.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
SP TIB/PER REVASC W/STENT
|
Facility
|
IP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 37230
|
| Hospital Charge Code |
41101442
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$20,278.00
|
|
|
SP TIB/PER REVASC W/STENT
|
Facility
|
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 37230
|
| Hospital Charge Code |
41101442
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$36,208.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14,194.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14,194.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14,194.60
|
| Rate for Payer: Brighton Health Commercial |
$36,208.64
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$20,278.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Humana Medicare |
$20,683.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
SP TIB/PERUCT REVASC W/TLA UNI
|
Facility
|
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37228
|
| Hospital Charge Code |
41546561
|
|
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 |
$2,546.00
|
| 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 TIB/PERUCT REVASC W/TLA UNI
|
Facility
|
IP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37228
|
| Hospital Charge Code |
41546561
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,721.98
|
|
|
SP TIPS EXCLUDING EMBOLIZATION
|
Facility
|
OP
|
$6,574.83
|
|
|
Service Code
|
HCPCS 37182 TC
|
| Hospital Charge Code |
41561846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.45 |
| Max. Negotiated Rate |
$4,931.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,616.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$887.45
|
| Rate for Payer: Aetna Government |
$887.45
|
| Rate for Payer: Brighton Health Commercial |
$4,931.12
|
| 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 |
$3,287.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,301.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,287.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,287.42
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
|
|
SP TIPS REVISION
|
Facility
|
IP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37183 TC
|
| Hospital Charge Code |
41561839
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,609.72
|
|
|
SP TIPS REVISION
|
Facility
|
OP
|
$15,004.15
|
|
|
Service Code
|
HCPCS 37183 TC
|
| Hospital Charge Code |
41561839
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$11,253.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| 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 |
$3,190.00
|
| 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 TIPSS - ANASTO. PORTOCAVAL
|
Facility
|
OP
|
$4,320.82
|
|
|
Service Code
|
HCPCS 37140 TC
|
| Hospital Charge Code |
41546003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$3,240.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,376.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,576.98
|
| Rate for Payer: Aetna Government |
$2,576.98
|
| Rate for Payer: Brighton Health Commercial |
$3,240.62
|
| 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 |
$2,160.41
|
| Rate for Payer: Group Health Inc Medicare |
$1,512.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,160.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,160.41
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP TMJ ARTHOGRAM
|
Facility
|
OP
|
$122.03
|
|
|
Service Code
|
HCPCS 21116 TC
|
| Hospital Charge Code |
41561913
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.86
|
| Rate for Payer: Aetna Government |
$147.86
|
| Rate for Payer: Brighton Health Commercial |
$91.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$61.02
|
| Rate for Payer: Group Health Inc Medicare |
$42.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.02
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP TRANSCATHETER BILIARY BIOPSY
|
Facility
|
IP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47553 TC
|
| Hospital Charge Code |
41547649
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$8,748.99
|
|
|
SP TRANSCATHETER BILIARY BIOPSY
|
Facility
|
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47553 TC
|
| Hospital Charge Code |
41547649
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$8,923.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,748.99
|
| Rate for Payer: Aetna Government |
$8,748.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,124.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,124.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,124.29
|
| Rate for Payer: Brighton Health Commercial |
$7,063.07
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Cash Price |
$8,748.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,748.99
|
| 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 |
$8,748.99
|
| Rate for Payer: EmblemHealth Commercial |
$745.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,436.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,786.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,748.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,786.60
|
| Rate for Payer: Group Health Inc Commercial |
$8,748.99
|
| Rate for Payer: Group Health Inc Medicare |
$8,748.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,748.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,436.64
|
| Rate for Payer: Healthfirst QHP |
$8,748.99
|
| Rate for Payer: Humana Medicare |
$8,923.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,748.99
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,748.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,748.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,999.19
|
| Rate for Payer: Wellcare Medicare |
$8,311.54
|
|
|
SP TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37200 TC
|
| Hospital Charge Code |
41547693
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,888.00 |
| Max. Negotiated Rate |
$10,440.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37200 TC
|
| Hospital Charge Code |
41547693
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
SP TRANSCATH STENT CCA W/EPS
|
Facility
|
OP
|
$8,432.56
|
|
|
Service Code
|
HCPCS 37215 TC
|
| Hospital Charge Code |
41562369
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,132.16 |
| Max. Negotiated Rate |
$6,324.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,637.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,132.16
|
| Rate for Payer: Aetna Government |
$1,132.16
|
| Rate for Payer: Brighton Health Commercial |
$6,324.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$4,216.28
|
| Rate for Payer: Group Health Inc Medicare |
$2,951.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,216.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,216.28
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
SP TRANSCATH STENT CCA W/O EPS
|
Facility
|
OP
|
$8,432.56
|
|
|
Service Code
|
HCPCS 37216 TC
|
| Hospital Charge Code |
41562371
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$6,324.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,614.84
|
| Rate for Payer: Aetna Government |
$4,614.84
|
| Rate for Payer: Brighton Health Commercial |
$6,324.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$4,216.28
|
| Rate for Payer: Group Health Inc Medicare |
$2,951.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,216.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,216.28
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
