|
ED THORACIC-US EXAM CHEST
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76604 TC
|
| Hospital Charge Code |
41303340
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
ED & TRAIN, 2-4 PTS
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 98961
|
| Hospital Charge Code |
30105455
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.24
|
| Rate for Payer: Aetna Government |
$12.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.40
|
| Rate for Payer: Amida Care Medicaid |
$20.40
|
| Rate for Payer: Brighton Health Commercial |
$105.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,040.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.42
|
| 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 |
$20.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.40
|
| Rate for Payer: Healthfirst Essential Plan |
$45.90
|
| Rate for Payer: Healthfirst QHP |
$20.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.40
|
| Rate for Payer: SOMOS Essential |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$70.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.44
|
| Rate for Payer: United Healthcare Medicaid |
$20.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.40
|
|
|
ED & TRAIN 5-8 PTS
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 98962
|
| Hospital Charge Code |
30105456
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.06
|
| Rate for Payer: Aetna Government |
$9.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.40
|
| Rate for Payer: Amida Care Medicaid |
$20.40
|
| Rate for Payer: Brighton Health Commercial |
$105.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,040.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.42
|
| 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 |
$20.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.40
|
| Rate for Payer: Healthfirst Essential Plan |
$45.90
|
| Rate for Payer: Healthfirst QHP |
$20.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.40
|
| Rate for Payer: SOMOS Essential |
$45.90
|
| Rate for Payer: United Healthcare Commercial |
$70.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.44
|
| Rate for Payer: United Healthcare Medicaid |
$20.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.40
|
|
|
ED & TRAIN PT, INDIVID EA 30 MIN
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 98960
|
| Hospital Charge Code |
30105454
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.43
|
| Rate for Payer: Aetna Government |
$25.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$91.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$91.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$40.80
|
| Rate for Payer: Amida Care Medicaid |
$40.80
|
| Rate for Payer: Brighton Health Commercial |
$105.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,080.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.84
|
| 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 |
$40.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.80
|
| Rate for Payer: Healthfirst Essential Plan |
$91.80
|
| Rate for Payer: Healthfirst QHP |
$40.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.80
|
| Rate for Payer: SOMOS Essential |
$91.80
|
| Rate for Payer: United Healthcare Commercial |
$70.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$91.80
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$44.88
|
| Rate for Payer: United Healthcare Medicaid |
$40.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40.80
|
|
|
ED ULTRASOUND, PREG UTERUS REALTI
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76817 TC
|
| Hospital Charge Code |
41300900
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
ED ULTRASOUND, PREG UTERUS REALTI
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76817 TC
|
| Hospital Charge Code |
41300900
|
|
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
|
|
|
ED UNLISTED PROCEDURE CODE
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 76999
|
| Hospital Charge Code |
41391121
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
ED UNLISTED PROCEDURE CODE
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76999
|
| Hospital Charge Code |
41391121
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$132.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| Rate for Payer: Brighton Health Commercial |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| 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 |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$73.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$94.57
|
| Rate for Payer: Group Health Inc Medicare |
$94.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.08
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare Commercial |
$49.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
ED US, ABDOM, B-SCAN
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Hospital Charge Code |
41301145
|
|
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
|
|
|
ED US, ABDOM, B-SCAN
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Hospital Charge Code |
41301145
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
ED US AORTA
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Hospital Charge Code |
41301535
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
ED US AORTA
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76775 TC
|
| Hospital Charge Code |
41301535
|
|
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
|
|
|
ED US BILIARY
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Hospital Charge Code |
41301534
|
|
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
|
|
|
ED US BILIARY
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Hospital Charge Code |
41301534
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
ED US FAST
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Hospital Charge Code |
41301533
|
|
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
|
|
|
ED US FAST
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76705 TC
|
| Hospital Charge Code |
41301533
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
ED US-GUIDED PARACENTESIS
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
41301129
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
ED US-GUIDED PARACENTESIS
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
30105999
|
|
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 |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,048.28
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| 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 |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ED US-GUIDED PARACENTESIS
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
30105999
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
ED US-GUIDED PARACENTESIS
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
41301129
|
|
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 |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,048.28
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| 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 |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ED US-GUIDED VASCULAR ACESS
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 76937 TC
|
| Hospital Charge Code |
41301131
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.39
|
| Rate for Payer: Aetna Government |
$13.39
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
|
|
ED US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 76942 TC
|
| Hospital Charge Code |
41301565
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$915.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.62
|
| Rate for Payer: Aetna Government |
$21.62
|
| Rate for Payer: Brighton Health Commercial |
$858.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$915.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$778.19
|
| Rate for Payer: Group Health Inc Commercial |
$572.20
|
| Rate for Payer: Group Health Inc Medicare |
$400.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.20
|
|
|
ED US, GUIDE FOR PERICARDIOCENTES
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 33016 TC
|
| Hospital Charge Code |
41301561
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,296.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,852.05
|
| Rate for Payer: Aetna Government |
$1,852.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,296.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,296.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,296.44
|
| Rate for Payer: Brighton Health Commercial |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Cash Price |
$1,852.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,852.05
|
| 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 |
$1,852.05
|
| Rate for Payer: EmblemHealth Commercial |
$1,296.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,574.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,574.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,648.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,852.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,648.32
|
| Rate for Payer: Group Health Inc Commercial |
$1,666.84
|
| Rate for Payer: Group Health Inc Medicare |
$1,666.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,574.24
|
| Rate for Payer: Healthfirst QHP |
$1,852.05
|
| Rate for Payer: Humana Medicare |
$1,889.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,852.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,481.64
|
| Rate for Payer: Wellcare Medicare |
$1,759.45
|
|
|
ED US, GUIDE FOR PERICARDIOCENTES
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 33016 TC
|
| Hospital Charge Code |
41301561
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
ED US, GUIDE FOR VASC ACCESS
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 76937 TC
|
| Hospital Charge Code |
41301563
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.39
|
| Rate for Payer: Aetna Government |
$13.39
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
|
