SP TRANSCERVICAL - FALLOPIAN
|
Facility
|
IP
|
$7,566.13
|
|
Service Code
|
HCPCS 58345 TC
|
Hospital Charge Code |
41547462
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$3,615.39
|
|
SP TRANSCERVICAL - FALLOPIAN
|
Facility
|
OP
|
$7,566.13
|
|
Service Code
|
HCPCS 58345 TC
|
Hospital Charge Code |
41547462
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$1,468.00 |
Max. Negotiated Rate |
$5,674.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
Rate for Payer: Aetna Government |
$3,615.39
|
Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
Rate for Payer: Brighton Health Commercial |
$5,674.60
|
Rate for Payer: Cash Price |
$3,615.39
|
Rate for Payer: Cash Price |
$3,615.39
|
Rate for Payer: Cash Price |
$3,615.39
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
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 |
$3,615.39
|
Rate for Payer: EmblemHealth Commercial |
$3,615.39
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
Rate for Payer: Healthfirst QHP |
$3,615.39
|
Rate for Payer: Humana Medicare |
$3,687.70
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
Rate for Payer: United Healthcare Commercial |
$1,468.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
SP TRANSHEPA PORTOGRAPHY W/O HEMO
|
Facility
|
OP
|
$1,249.78
|
|
Service Code
|
HCPCS 36481 TC
|
Hospital Charge Code |
41547687
|
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 TRANSJUGULAR LIVER BIOPSY
|
Facility
|
OP
|
$13,920.70
|
|
Service Code
|
HCPCS 37200 TC
|
Hospital Charge Code |
41547653
|
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 TRANSJUGULAR LIVER BIOPSY
|
Facility
|
IP
|
$13,920.70
|
|
Service Code
|
HCPCS 37200 TC
|
Hospital Charge Code |
41547653
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$6,354.94
|
|
SP TREAT SPINAL CANAL LESION
|
Facility
|
IP
|
$2,459.50
|
|
Service Code
|
HCPCS 62282
|
Hospital Charge Code |
41561541
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$1,054.06
|
|
SP TREAT SPINAL CANAL LESION
|
Facility
|
OP
|
$2,459.50
|
|
Service Code
|
HCPCS 62282
|
Hospital Charge Code |
41561541
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$737.84 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
Rate for Payer: Aetna Government |
$1,054.06
|
Rate for Payer: Affinity Essential Plan 1&2 |
$737.84
|
Rate for Payer: Affinity Essential Plan 3&4 |
$737.84
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$737.84
|
Rate for Payer: Brighton Health Commercial |
$1,844.62
|
Rate for Payer: Cash Price |
$1,054.06
|
Rate for Payer: Cash Price |
$1,054.06
|
Rate for Payer: Cash Price |
$1,054.06
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
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: Elderplan Medicare Advantage |
$1,054.06
|
Rate for Payer: EmblemHealth Commercial |
$1,054.06
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
Rate for Payer: Group Health Inc Commercial |
$1,054.06
|
Rate for Payer: Group Health Inc Medicare |
$1,054.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
Rate for Payer: Healthfirst QHP |
$1,054.06
|
Rate for Payer: Humana Medicare |
$1,075.14
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
Rate for Payer: United Healthcare Commercial |
$1,188.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$1,054.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
SP TREAT SPINAL CORD LESION
|
Facility
|
OP
|
$2,459.50
|
|
Service Code
|
HCPCS 62281
|
Hospital Charge Code |
41561540
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$737.84 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
Rate for Payer: Aetna Government |
$1,054.06
|
Rate for Payer: Affinity Essential Plan 1&2 |
$737.84
|
Rate for Payer: Affinity Essential Plan 3&4 |
$737.84
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$737.84
|
Rate for Payer: Brighton Health Commercial |
$1,844.62
|
Rate for Payer: Cash Price |
$1,054.06
|
Rate for Payer: Cash Price |
$1,054.06
|
Rate for Payer: Cash Price |
$1,054.06
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
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: Elderplan Medicare Advantage |
$1,054.06
|
Rate for Payer: EmblemHealth Commercial |
$1,054.06
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
Rate for Payer: Group Health Inc Commercial |
$1,054.06
|
Rate for Payer: Group Health Inc Medicare |
$1,054.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.75
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
Rate for Payer: Healthfirst QHP |
$1,054.06
|
Rate for Payer: Humana Medicare |
$1,075.14
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
Rate for Payer: United Healthcare Commercial |
$1,188.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$1,054.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
SP TREAT SPINAL CORD LESION
|
Facility
|
IP
|
$2,459.50
|
|
Service Code
|
HCPCS 62281
|
Hospital Charge Code |
41561540
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$1,054.06
|
|
SP TUN CATHETER EXCH PERM
|
Facility
|
OP
|
$8,393.53
|
|
Service Code
|
HCPCS 36581 TC
|
Hospital Charge Code |
41549845
|
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 TUN CATHETER EXCH PERM
|
Facility
|
IP
|
$8,393.53
|
|
Service Code
|
HCPCS 36581 TC
|
Hospital Charge Code |
41549845
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$3,686.08
|
|
SP TUN CATHETER INS PERM
|
Facility
|
IP
|
$8,393.53
|
|
Service Code
|
HCPCS 36558 TC
|
Hospital Charge Code |
41549843
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$3,686.08
|
|
SP TUN CATHETER INS PERM
|
Facility
|
OP
|
$8,393.53
|
|
Service Code
|
HCPCS 36558 TC
|
Hospital Charge Code |
41549843
|
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 TUN CATHETER RMVL PERM
|
Facility
|
OP
|
$1,909.65
|
|
Service Code
|
HCPCS 36589 TC
|
Hospital Charge Code |
41549847
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$508.53 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
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 TUN CATHETER RMVL PERM
|
Facility
|
IP
|
$1,909.65
|
|
Service Code
|
HCPCS 36589 TC
|
Hospital Charge Code |
41549847
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$726.47
|
|
SP URETERAL EMBOLIZATION/OCCL
|
Facility
|
OP
|
$2,804.37
|
|
Service Code
|
HCPCS 50705
|
Hospital Charge Code |
41542912
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$247.02 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.02
|
Rate for Payer: Aetna Government |
$247.02
|
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 URETERAL PTA
|
Facility
|
OP
|
$12,816.53
|
|
Service Code
|
HCPCS 50553 TC
|
Hospital Charge Code |
41547737
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$745.00 |
Max. Negotiated Rate |
$9,612.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,983.74
|
Rate for Payer: Aetna Government |
$5,983.74
|
Rate for Payer: Affinity Essential Plan 1&2 |
$4,188.62
|
Rate for Payer: Affinity Essential Plan 3&4 |
$4,188.62
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,188.62
|
Rate for Payer: Brighton Health Commercial |
$9,612.40
|
Rate for Payer: Cash Price |
$5,983.74
|
Rate for Payer: Cash Price |
$5,983.74
|
Rate for Payer: Cash Price |
$5,983.74
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,983.74
|
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 |
$5,983.74
|
Rate for Payer: EmblemHealth Commercial |
$745.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$5,086.18
|
Rate for Payer: Fidelis Essential Plan QHP |
$5,325.53
|
Rate for Payer: Fidelis Medicare Advantage |
$5,983.74
|
Rate for Payer: Fidelis Qualified Health Plan |
$5,325.53
|
Rate for Payer: Group Health Inc Commercial |
$5,983.74
|
Rate for Payer: Group Health Inc Medicare |
$5,983.74
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5,983.74
|
Rate for Payer: Healthfirst Medicare Advantage |
$5,086.18
|
Rate for Payer: Healthfirst QHP |
$5,983.74
|
Rate for Payer: Humana Medicare |
$6,103.41
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$5,983.74
|
Rate for Payer: United Healthcare Commercial |
$1,468.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$5,983.74
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,983.74
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,786.99
|
Rate for Payer: Wellcare Medicare |
$5,684.55
|
|
SP URETERAL PTA
|
Facility
|
IP
|
$12,816.53
|
|
Service Code
|
HCPCS 50553 TC
|
Hospital Charge Code |
41547737
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$5,983.74
|
|
SP URETERAL STENT
|
Facility
|
OP
|
$9,142.40
|
|
Service Code
|
HCPCS 50694 TC
|
Hospital Charge Code |
41546559
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$1,835.00 |
Max. Negotiated Rate |
$6,856.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
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 |
$1,835.00
|
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 URETERAL STENT
|
Facility
|
IP
|
$9,142.40
|
|
Service Code
|
HCPCS 50694 TC
|
Hospital Charge Code |
41546559
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$4,031.47
|
|
SP URETHROCYSTOGRAM, RETRO
|
Facility
|
OP
|
$855.81
|
|
Service Code
|
HCPCS 51610 TC
|
Hospital Charge Code |
41542828
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$129.47 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.47
|
Rate for Payer: Aetna Government |
$129.47
|
Rate for Payer: Brighton Health Commercial |
$641.86
|
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 |
$427.90
|
Rate for Payer: Group Health Inc Medicare |
$299.53
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.90
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$427.90
|
Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
SP URETHROCYSTOGRAM VOID
|
Facility
|
OP
|
$605.55
|
|
Service Code
|
HCPCS 51600 TC
|
Hospital Charge Code |
41542526
|
Hospital Revenue Code
|
361
|
Min. Negotiated Rate |
$211.94 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$224.79
|
Rate for Payer: Aetna Government |
$224.79
|
Rate for Payer: Brighton Health Commercial |
$454.16
|
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 |
$302.78
|
Rate for Payer: Group Health Inc Medicare |
$211.94
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.78
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$302.78
|
Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
SP US GUIDED 1ST LOCAL
|
Facility
|
OP
|
$1,847.58
|
|
Service Code
|
HCPCS 19285 TC
|
Hospital Charge Code |
41104043
|
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 |
$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 US GUIDED 1ST LOCAL
|
Facility
|
IP
|
$1,847.58
|
|
Service Code
|
HCPCS 19285 TC
|
Hospital Charge Code |
41104043
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$813.63
|
|
SP US GUIDED BREAST ADD
|
Facility
|
OP
|
$1,042.00
|
|
Service Code
|
HCPCS 19084
|
Hospital Charge Code |
41104021
|
Hospital Revenue Code
|
402
|
Min. Negotiated Rate |
$68.16 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$68.16
|
Rate for Payer: Aetna Government |
$68.16
|
Rate for Payer: Brighton Health Commercial |
$781.50
|
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 |
$521.00
|
Rate for Payer: Group Health Inc Medicare |
$364.70
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$521.00
|
|