|
CYSTECTOMY
|
Facility
|
OP
|
$3,141.35
|
|
|
Service Code
|
HCPCS 51550
|
| Hospital Charge Code |
40122915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,099.47 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,727.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,181.98
|
| Rate for Payer: Aetna Government |
$1,181.98
|
| Rate for Payer: Brighton Health Commercial |
$2,356.01
|
| 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 |
$1,570.67
|
| Rate for Payer: Group Health Inc Medicare |
$1,099.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,570.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,570.67
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
CYST HAND
|
Facility
|
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
40021730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,117.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Brighton Health Commercial |
$3,117.94
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
CYST HAND
|
Facility
|
IP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 11420
|
| Hospital Charge Code |
40021730
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,874.89
|
|
|
CYSTICERCOSIS AB,IGG,ELISA,CSF
|
Facility
|
IP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40729901
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$13.01
|
|
|
CYSTICERCOSIS AB,IGG,ELISA,CSF
|
Facility
|
OP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40729901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.11
|
| Rate for Payer: Brighton Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.01
|
| Rate for Payer: EmblemHealth Commercial |
$13.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.58
|
| Rate for Payer: Group Health Inc Commercial |
$13.01
|
| Rate for Payer: Group Health Inc Medicare |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.01
|
| Rate for Payer: Healthfirst QHP |
$13.01
|
| Rate for Payer: Humana Medicare |
$13.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.41
|
| Rate for Payer: Wellcare Medicare |
$11.71
|
|
|
CYSTICERCOSIS (TAENIA SOLIUM)
|
Facility
|
OP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40619168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.11
|
| Rate for Payer: Brighton Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.01
|
| Rate for Payer: EmblemHealth Commercial |
$13.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.58
|
| Rate for Payer: Group Health Inc Commercial |
$13.01
|
| Rate for Payer: Group Health Inc Medicare |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.01
|
| Rate for Payer: Healthfirst QHP |
$13.01
|
| Rate for Payer: Humana Medicare |
$13.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.41
|
| Rate for Payer: Wellcare Medicare |
$11.71
|
|
|
CYSTICERCOSIS (TAENIA SOLIUM)
|
Facility
|
IP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40619168
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.01
|
|
|
CYSTIC FIBROSIS PROFILE
|
Facility
|
IP
|
$1,391.50
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
40609027
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$556.60
|
|
|
CYSTIC FIBROSIS PROFILE
|
Facility
|
OP
|
$1,391.50
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
40609027
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$389.62 |
| Max. Negotiated Rate |
$1,113.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$765.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$556.60
|
| Rate for Payer: Aetna Government |
$556.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$389.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$389.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$389.62
|
| Rate for Payer: Brighton Health Commercial |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$556.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,113.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$946.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$556.60
|
| Rate for Payer: EmblemHealth Commercial |
$556.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$473.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$556.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.37
|
| Rate for Payer: Group Health Inc Commercial |
$556.60
|
| Rate for Payer: Group Health Inc Medicare |
$556.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$556.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$556.60
|
| Rate for Payer: Healthfirst QHP |
$556.60
|
| Rate for Payer: Humana Medicare |
$567.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$556.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$556.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$556.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$445.28
|
| Rate for Payer: Wellcare Medicare |
$500.94
|
|
|
CYSTINE, QUANT. 24 HR URINE
|
Facility
|
IP
|
$57.45
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
40609875
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$22.98
|
|
|
CYSTINE, QUANT. 24 HR URINE
|
Facility
|
OP
|
$57.45
|
|
|
Service Code
|
HCPCS 82131
|
| Hospital Charge Code |
40609875
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.09 |
| Max. Negotiated Rate |
$43.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.98
|
| Rate for Payer: Aetna Government |
$22.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.09
|
| Rate for Payer: Brighton Health Commercial |
$43.09
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.98
|
| Rate for Payer: EmblemHealth Commercial |
$22.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.45
|
| Rate for Payer: Group Health Inc Commercial |
$22.98
|
| Rate for Payer: Group Health Inc Medicare |
$22.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.98
|
| Rate for Payer: Healthfirst QHP |
$22.98
|
| Rate for Payer: Humana Medicare |
$23.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.98
|
| Rate for Payer: United Healthcare Commercial |
$21.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.38
|
| Rate for Payer: Wellcare Medicare |
$20.68
|
|
|
CYSTO AND TREATMENT COMPLICATED
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 52315
|
| Hospital Charge Code |
40129950
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$4,024.18
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
CYSTO AND TREATMENT COMPLICATED
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 52315
|
| Hospital Charge Code |
40129950
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
CYSTOGRAM TRAY
|
Facility
|
OP
|
$65.21
|
|
| Hospital Charge Code |
40200940
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.60
|
| Rate for Payer: Aetna Government |
$32.60
|
| Rate for Payer: Brighton Health Commercial |
$48.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.34
|
| Rate for Payer: Group Health Inc Commercial |
$32.60
|
| Rate for Payer: Group Health Inc Medicare |
$22.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.60
|
|
|
CYSTO, INTERNAL URETHROTOMY
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
40122955
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
CYSTO, INTERNAL URETHROTOMY
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 52276
|
| Hospital Charge Code |
40122955
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$4,024.18
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
CYSTO, INTERNAL URETHROTOMY FEMAL
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 52270
|
| Hospital Charge Code |
40054236
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
CYSTO, INTERNAL URETHROTOMY FEMAL
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 52270
|
| Hospital Charge Code |
40054236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$4,024.18
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
CYSTO, INTERNAL URETHROTOMY MALE
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 52275
|
| Hospital Charge Code |
40129949
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,024.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$4,024.18
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
CYSTO, INTERNAL URETHROTOMY MALE
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 52275
|
| Hospital Charge Code |
40129949
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
CYSTO - IRRIGATION BLADDER
|
Facility
|
IP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
40129812
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,031.47
|
|
|
CYSTO - IRRIGATION BLADDER
|
Facility
|
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 52001
|
| Hospital Charge Code |
40129812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$6,856.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$1,505.00
|
| 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 |
$1,409.00
|
| 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
|
|
|
CYSTO IRRIG. SET
|
Facility
|
OP
|
$26.93
|
|
| Hospital Charge Code |
40509811
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.46
|
| Rate for Payer: Aetna Government |
$13.46
|
| Rate for Payer: Brighton Health Commercial |
$20.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.31
|
| Rate for Payer: Group Health Inc Commercial |
$13.46
|
| Rate for Payer: Group Health Inc Medicare |
$9.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.46
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
CYSTOMETROGRAM W/VP&UP
|
Facility
|
OP
|
$1,701.00
|
|
|
Service Code
|
HCPCS 51729 TC
|
| Hospital Charge Code |
30302039
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$789.96
|
| Rate for Payer: Aetna Government |
$789.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$552.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$552.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$552.97
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$789.96
|
| Rate for Payer: Cash Price |
$789.96
|
| Rate for Payer: Cash Price |
$789.96
|
| Rate for Payer: Cash Price |
$789.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$789.96
|
| 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 |
$789.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$671.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$703.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$789.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$703.06
|
| 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 |
$850.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$789.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$671.47
|
| Rate for Payer: Healthfirst QHP |
$789.96
|
| Rate for Payer: Humana Medicare |
$805.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$789.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$789.96
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$789.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$789.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$631.97
|
| Rate for Payer: Wellcare Medicare |
$750.46
|
|
|
CYSTOMETROGRAM W/VP&UP
|
Facility
|
IP
|
$1,701.00
|
|
|
Service Code
|
HCPCS 51729 TC
|
| Hospital Charge Code |
30302039
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$789.96
|
|
