|
CREATININE CLEARANCE
|
Facility
|
IP
|
$23.65
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
40602300
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$9.46
|
|
|
CREATININE CLEARANCE
|
Facility
|
OP
|
$23.65
|
|
|
Service Code
|
HCPCS 82575
|
| Hospital Charge Code |
40602300
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.46
|
| Rate for Payer: Aetna Government |
$9.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.62
|
| Rate for Payer: Brighton Health Commercial |
$17.74
|
| Rate for Payer: Cash Price |
$9.46
|
| Rate for Payer: Cash Price |
$9.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.46
|
| Rate for Payer: EmblemHealth Commercial |
$9.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.42
|
| Rate for Payer: Group Health Inc Commercial |
$9.46
|
| Rate for Payer: Group Health Inc Medicare |
$9.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.46
|
| Rate for Payer: Healthfirst QHP |
$9.46
|
| Rate for Payer: Humana Medicare |
$9.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.46
|
| Rate for Payer: United Healthcare Commercial |
$11.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.57
|
| Rate for Payer: Wellcare Medicare |
$8.51
|
|
|
CREATININE RANDOM URINE
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40602570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
CREATININE RANDOM URINE
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40602570
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft
|
Facility
|
OP
|
$6,482.04
|
|
|
Service Code
|
CPT 36825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,482.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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: 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 |
$1,505.00
|
| 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 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
|
|
|
CREAT U+ALDO U
|
Facility
|
OP
|
$101.36
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
40609035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$76.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.75
|
| Rate for Payer: Aetna Government |
$40.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28.52
|
| Rate for Payer: Brighton Health Commercial |
$76.02
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.75
|
| Rate for Payer: EmblemHealth Commercial |
$40.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.27
|
| Rate for Payer: Group Health Inc Commercial |
$40.75
|
| Rate for Payer: Group Health Inc Medicare |
$40.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.75
|
| Rate for Payer: Healthfirst QHP |
$40.75
|
| Rate for Payer: Humana Medicare |
$41.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.75
|
| Rate for Payer: United Healthcare Commercial |
$51.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.60
|
| Rate for Payer: Wellcare Medicare |
$36.68
|
|
|
CREAT U+ALDO U
|
Facility
|
IP
|
$101.36
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
40609035
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$40.75
|
|
|
CREATU+CORT U
|
Facility
|
IP
|
$41.78
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
40609055
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.71
|
|
|
CREATU+CORT U
|
Facility
|
OP
|
$41.78
|
|
|
Service Code
|
HCPCS 82530
|
| Hospital Charge Code |
40609055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$31.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.71
|
| Rate for Payer: Aetna Government |
$16.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.70
|
| Rate for Payer: Brighton Health Commercial |
$31.34
|
| Rate for Payer: Cash Price |
$16.71
|
| Rate for Payer: Cash Price |
$16.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.71
|
| Rate for Payer: EmblemHealth Commercial |
$16.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.87
|
| Rate for Payer: Group Health Inc Commercial |
$16.71
|
| Rate for Payer: Group Health Inc Medicare |
$16.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.71
|
| Rate for Payer: Healthfirst QHP |
$16.71
|
| Rate for Payer: Humana Medicare |
$17.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare Commercial |
$21.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.37
|
| Rate for Payer: Wellcare Medicare |
$15.04
|
|
|
CREATU+PBG24U+PORPHY(U)
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
CREATU+PBG24U+PORPHY(U)
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609819
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
CREAT U+PE U
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
CREAT U+PE U
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609858
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
CREATU+PE UU
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609060
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
CREATU+PE UU
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
CREATU+VMA24U
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609062
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
CREATU+VMA24U
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 82570
|
| Hospital Charge Code |
40609062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
C REP S/A/L, 1.1-2.5CM
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
30102453
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.40
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$726.29
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| 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 |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Humana Medicare |
$740.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
C REP S/A/L, 1.1-2.5CM
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
30302483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Humana Medicare |
$740.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
C REP S/A/L, 1.1-2.5CM
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
30102453
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
C REP S/A/L, 1.1-2.5CM
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
30302483
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
C REP S/A/L, 1.1-2.5CM
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
40019686
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
C REP S/A/L, 1.1-2.5CM
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13120
|
| Hospital Charge Code |
40019686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$508.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.40
|
| Rate for Payer: Brighton Health Commercial |
$1,129.01
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Humana Medicare |
$740.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
C REP TRUNK, 1.1-2.5CM
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
30103262
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.40
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$726.29
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| 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 |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Humana Medicare |
$740.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
C REP TRUNK, 1.1-2.5CM
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 13100
|
| Hospital Charge Code |
30103262
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$726.29
|
|
