|
US PREGNANCY LIMITED
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76815 TC
|
| Hospital Charge Code |
41304008
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$186.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$49.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
US PVR ARTERIES UP/LOW EXTREM
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 93923 TC
|
| Hospital Charge Code |
41307392
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
US PVR ARTERIES UP/LOW EXTREM
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93923 TC
|
| Hospital Charge Code |
41307392
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
US RETROPERITONEL COMPLETE
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76770 TC
|
| Hospital Charge Code |
41304024
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
US RETROPERITONEL COMPLETE
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76770 TC
|
| Hospital Charge Code |
41304024
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
US RETROPERITONEL LIMITED
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Hospital Charge Code |
41304012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
US RETROPERITONEL LIMITED
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Hospital Charge Code |
41304012
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
US SCROTUM
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76870 TC
|
| Hospital Charge Code |
41304034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
US SCROTUM
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76870 TC
|
| Hospital Charge Code |
41304034
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
US SPINAL SONO
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76800 TC
|
| Hospital Charge Code |
41304026
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
US SPINAL SONO
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76800 TC
|
| Hospital Charge Code |
41304026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
USTEKINUMAB 130 MG/26ML IV SOLN [134899]
|
Facility
|
IP
|
$93.44
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
57894005427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.72
|
|
|
USTEKINUMAB 130 MG/26ML IV SOLN [134899]
|
Facility
|
OP
|
$93.44
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
57894005427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$60.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.62
|
| Rate for Payer: Aetna Government |
$12.62
|
| Rate for Payer: Brighton Health Commercial |
$56.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$46.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.62
|
| Rate for Payer: EmblemHealth Commercial |
$46.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.62
|
| Rate for Payer: Group Health Inc Commercial |
$12.62
|
| Rate for Payer: Group Health Inc Medicare |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.73
|
| Rate for Payer: Healthfirst QHP |
$12.62
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
|
|
USTEKINUMAB IV INJ
|
Facility
|
IP
|
$76.95
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
41640211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$38.48 |
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.48
|
|
|
USTEKINUMAB IV INJ
|
Facility
|
IP
|
$76.95
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
41650211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$38.48 |
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.48
|
|
|
USTEKINUMAB IV INJ
|
Facility
|
OP
|
$76.95
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
41640211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$50.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.62
|
| Rate for Payer: Aetna Government |
$12.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.83
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.83
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.83
|
| Rate for Payer: Brighton Health Commercial |
$46.17
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.62
|
| Rate for Payer: EmblemHealth Commercial |
$12.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.25
|
| Rate for Payer: Group Health Inc Commercial |
$12.62
|
| Rate for Payer: Group Health Inc Medicare |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.73
|
| Rate for Payer: Healthfirst QHP |
$12.62
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.24
|
| Rate for Payer: SOMOS Essential |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$12.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
|
|
USTEKINUMAB IV INJ
|
Facility
|
OP
|
$76.95
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
41650211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$50.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.62
|
| Rate for Payer: Aetna Government |
$12.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.83
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.83
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.83
|
| Rate for Payer: Brighton Health Commercial |
$46.17
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.62
|
| Rate for Payer: EmblemHealth Commercial |
$12.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.25
|
| Rate for Payer: Group Health Inc Commercial |
$12.62
|
| Rate for Payer: Group Health Inc Medicare |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.73
|
| Rate for Payer: Healthfirst QHP |
$12.62
|
| Rate for Payer: Humana Medicare |
$12.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.24
|
| Rate for Payer: SOMOS Essential |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$12.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.10
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
|
|
US THORACENTESIS FOR ASPIRATION
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
41304048
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$726.47
|
|
|
US THORACENTESIS FOR ASPIRATION
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
41304048
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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
|
|
|
US THORACENTESIS W/IMAGE GUIDE
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
30305660
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$726.47
|
|
|
US THORACENTESIS W/IMAGE GUIDE
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
30305660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$726.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$726.47
|
| 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 |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: Humana Medicare |
$741.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| 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
|
|
|
US THORACENTESIS W/IMAGE GUIDE
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
30105660
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$726.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$726.47
|
| 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 |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: Humana Medicare |
$741.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| 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
|
|
|
US THORACENTESIS W/IMAGE GUIDE
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 32555
|
| Hospital Charge Code |
30105660
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$726.47
|
|
|
US THYROID
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76536 TC
|
| Hospital Charge Code |
41301509
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
US THYROID
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76536 TC
|
| Hospital Charge Code |
41301509
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
