|
EPV TRASEPTAL CATH
|
Facility
OP
|
$8,094.10
|
|
|
Service Code
|
HCPCS 93462 TC
|
| Hospital Charge Code |
66574575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,832.94 |
| Max. Negotiated Rate |
$6,475.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,451.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,047.05
|
| Rate for Payer: Aetna Government |
$4,047.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,475.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,503.99
|
| Rate for Payer: Group Health Inc Commercial |
$4,047.05
|
| Rate for Payer: Group Health Inc Medicare |
$2,832.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,047.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,047.05
|
|
|
EPV T-WAVE ALTERNANS
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93025 TC
|
| Hospital Charge Code |
66574556
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$94.55 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$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: Fidelis CHP/HARP/Medicaid |
$94.55
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.06
|
|
|
EPV UNI ART GRAPH DUPLEX
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93926 TC
|
| Hospital Charge Code |
66574599
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.11
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.01
|
|
|
EPV US DUPLEX UNILATERAL
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93931 TC
|
| Hospital Charge Code |
66574602
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.30 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.30
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.78
|
|
|
EPV VENO VENOUS SINUS
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75860 TC
|
| Hospital Charge Code |
66574548
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.62 |
| Max. Negotiated Rate |
$6,714.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.62
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.69
|
|
|
EP VVI IMPLANT
|
Facility
OP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
66574504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$543.34 |
| Max. Negotiated Rate |
$16,751.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| Rate for Payer: Aetna Government |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,348.58
|
| 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 |
$12,348.58
|
| Rate for Payer: EmblemHealth Commercial |
$12,348.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$543.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,496.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,990.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,348.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,990.24
|
| Rate for Payer: Group Health Inc Commercial |
$12,348.58
|
| Rate for Payer: Group Health Inc Medicare |
$12,348.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,038.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$603.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,496.29
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,348.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,878.86
|
| Rate for Payer: Wellcare Medicare |
$11,731.15
|
|
|
EPZ W/DIPIRIDAMOLE PER 10MG
|
Facility
IP
|
$1.38
|
|
|
Service Code
|
HCPCS J1245
|
| Hospital Charge Code |
66574662
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
|
|
EPZ W/DIPIRIDAMOLE PER 10MG
|
Facility
OP
|
$1.38
|
|
|
Service Code
|
HCPCS J1245
|
| Hospital Charge Code |
66574662
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.65
|
| Rate for Payer: Aetna Government |
$3.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.96
|
| Rate for Payer: SOMOS Essential |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
EPZ W/DOBUTAMINE PER 250MG
|
Facility
IP
|
$3.52
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
66574663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.76
|
|
|
EPZ W/DOBUTAMINE PER 250MG
|
Facility
OP
|
$3.52
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
66574663
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.21
|
| Rate for Payer: Aetna Government |
$8.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.94
|
| Rate for Payer: Group Health Inc Commercial |
$1.76
|
| Rate for Payer: Group Health Inc Medicare |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.82
|
| Rate for Payer: SOMOS Essential |
$9.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.29
|
|
|
EQ ABCESS CATH. CHANGE
|
Facility
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Hospital Charge Code |
41107486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$325.20
|
| Rate for Payer: Aetna Government |
$325.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.76
|
| Rate for Payer: Group Health Inc Commercial |
$325.20
|
| Rate for Payer: Group Health Inc Medicare |
$227.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.07
|
|
|
EQ ABD AORTO.W/RUN-OFF
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75630 TC
|
| Hospital Charge Code |
41102540
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$6,714.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.68
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.64
|
|
|
EQ ABDOMINAL AORTOGRAM
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75625 TC
|
| Hospital Charge Code |
41102538
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.87 |
| Max. Negotiated Rate |
$6,714.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.87
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.30
|
|
|
EQ ABSCESS DRAINAGE, DEEP SFT TIS
|
Facility
OP
|
$453.64
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
41546558
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$362.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$249.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$226.82
|
| Rate for Payer: Aetna Government |
$226.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$362.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$308.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.66
|
| Rate for Payer: Group Health Inc Commercial |
$226.82
|
| Rate for Payer: Group Health Inc Medicare |
$158.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.84
|
|
|
EQ ABSCESS DRAINAGE, SUBUTANEOUS
|
Facility
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 75989
|
| Hospital Charge Code |
41548514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$122.28 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$962.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$124.04
|
| Rate for Payer: Aetna Government |
$124.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.28
|
| Rate for Payer: Group Health Inc Commercial |
$875.00
|
| Rate for Payer: Group Health Inc Medicare |
$612.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.87
|
|
|
EQ ABSCESS DRAINAGE, SUBUTANEOUS
|
Facility
OP
|
$453.64
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
41546556
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$362.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$249.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$226.82
|
| Rate for Payer: Aetna Government |
$226.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$362.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$308.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.66
|
| Rate for Payer: Group Health Inc Commercial |
$226.82
|
| Rate for Payer: Group Health Inc Medicare |
$158.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.84
|
|
|
EQ ABS.CTH.CK ABSCESSOGRAM
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Hospital Charge Code |
41107485
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.52
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.91
|
|
|
EQ ADRENAL ARTERY UNILATERAL
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75731 TC
|
| Hospital Charge Code |
41107471
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.12 |
| Max. Negotiated Rate |
$3,952.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,470.14
|
| Rate for Payer: Aetna Government |
$2,470.14
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,952.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,359.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.12
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.14
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.47
|
|
|
EQ ADRENAL, BILAT. ART
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75733 TC
|
| Hospital Charge Code |
41102580
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.84 |
| Max. Negotiated Rate |
$6,714.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.84
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.38
|
|
|
EQ ADRENAL VEN. BIL
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75842 TC
|
| Hospital Charge Code |
41102694
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.62 |
| Max. Negotiated Rate |
$11,136.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,656.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,960.35
|
| Rate for Payer: Aetna Government |
$6,960.35
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,136.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,466.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.62
|
| Rate for Payer: Group Health Inc Commercial |
$6,960.35
|
| Rate for Payer: Group Health Inc Medicare |
$4,872.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,960.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.58
|
|
|
EQ ADRENAL VEN. UNI
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75840 TC
|
| Hospital Charge Code |
41102693
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.20 |
| Max. Negotiated Rate |
$6,714.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,714.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,707.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.20
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.56
|
|
|
EQ ANGIO THRU EXIST. CTH
|
Facility
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75898 TC
|
| Hospital Charge Code |
41102608
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,729.10 |
| Max. Negotiated Rate |
$3,952.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,470.14
|
| Rate for Payer: Aetna Government |
$2,470.14
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,952.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,359.39
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.14
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.14
|
|
|
EQ ANKLE ARTHROGRAM
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73615 TC
|
| Hospital Charge Code |
41102490
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.55 |
| Max. Negotiated Rate |
$925.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.26
|
| Rate for Payer: Aetna Government |
$578.26
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$925.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.55
|
| Rate for Payer: Group Health Inc Commercial |
$578.26
|
| Rate for Payer: Group Health Inc Medicare |
$404.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.28
|
|
|
EQ BRONCH BRUSH/BIOPSY
|
Facility
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31628 TC
|
| Hospital Charge Code |
41102420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$4,892.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,892.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,447.59
|
| Rate for Payer: Aetna Government |
$4,447.59
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,447.59
|
| Rate for Payer: Group Health Inc Medicare |
$3,113.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,447.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,447.59
|
|
|
EQ BRONCH BRUSH/BIOPSY
|
Facility
OP
|
$8,895.18
|
|
|
Service Code
|
HCPCS 31628
|
| Hospital Charge Code |
30303385
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.38 |
| Max. Negotiated Rate |
$4,447.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,330.61
|
| Rate for Payer: Aetna Government |
$4,330.61
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Cash Price |
$4,330.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,330.61
|
| 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 |
$4,330.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,681.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,854.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,330.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,854.24
|
| 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 |
$4,447.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,330.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,681.02
|
| Rate for Payer: Healthfirst QHP |
$4,330.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,330.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,330.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,330.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,464.49
|
| Rate for Payer: Wellcare Medicare |
$4,114.08
|
|
