|
EQ DILATION OF NEPHROSTOM
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 74485 TC
|
| Hospital Charge Code |
41102532
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
EQ DILATION OF NEPHROSTOM
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 74485 TC
|
| Hospital Charge Code |
41102532
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,648.79 |
| Max. Negotiated Rate |
$2,951.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,951.07
|
| 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 |
$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 |
$2,422.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,049.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,648.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,002.11
|
| 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 |
$2,119.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,119.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,119.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,355.42
|
| 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 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
|
|
|
EQ EACH ADD. VESSEL
|
Facility
|
OP
|
$2,729.16
|
|
|
Service Code
|
HCPCS 75774 TC
|
| Hospital Charge Code |
41102594
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$2,183.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,501.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.37
|
| Rate for Payer: Aetna Government |
$55.37
|
| Rate for Payer: Brighton Health Commercial |
$2,046.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,183.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,855.83
|
| Rate for Payer: Group Health Inc Commercial |
$1,364.58
|
| Rate for Payer: Group Health Inc Medicare |
$955.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,364.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.58
|
|
|
EQ ELBOW ARTHROGRAM
|
Facility
|
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73085 TC
|
| Hospital Charge Code |
41102462
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.31 |
| Max. Negotiated Rate |
$636.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$444.73
|
| Rate for Payer: Aetna Government |
$444.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$311.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$311.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$311.31
|
| Rate for Payer: Brighton Health Commercial |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$550.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$465.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$444.73
|
| Rate for Payer: EmblemHealth Commercial |
$311.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$378.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$378.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$444.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.81
|
| Rate for Payer: Group Health Inc Commercial |
$400.26
|
| Rate for Payer: Group Health Inc Medicare |
$400.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$444.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$400.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$444.73
|
| Rate for Payer: Healthfirst QHP |
$444.73
|
| Rate for Payer: Humana Medicare |
$453.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$444.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$444.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$355.78
|
| Rate for Payer: Wellcare Medicare |
$422.49
|
|
|
EQ ELBOW ARTHROGRAM
|
Facility
|
IP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73085 TC
|
| Hospital Charge Code |
41102462
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$444.73
|
|
|
EQ EMBOLIZ. (EXTRACRANIAL)
|
Facility
|
OP
|
$3,200.13
|
|
|
Service Code
|
HCPCS 75894 TC
|
| Hospital Charge Code |
41102746
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$718.34 |
| Max. Negotiated Rate |
$2,560.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,760.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$718.34
|
| Rate for Payer: Aetna Government |
$718.34
|
| Rate for Payer: Brighton Health Commercial |
$2,400.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,560.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,176.09
|
| Rate for Payer: Group Health Inc Commercial |
$1,600.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,120.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,600.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,600.06
|
|
|
EQ EMBOLIZ. (INTRA/S. CORD)
|
Facility
|
OP
|
$3,200.13
|
|
|
Service Code
|
HCPCS 75894 TC
|
| Hospital Charge Code |
41102744
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$718.34 |
| Max. Negotiated Rate |
$2,560.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,760.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$718.34
|
| Rate for Payer: Aetna Government |
$718.34
|
| Rate for Payer: Brighton Health Commercial |
$2,400.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,560.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,176.09
|
| Rate for Payer: Group Health Inc Commercial |
$1,600.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,120.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,600.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,600.06
|
|
|
EQ EMBOLIZ. (NON-NEURO)
|
Facility
|
OP
|
$3,200.13
|
|
|
Service Code
|
HCPCS 75894 TC
|
| Hospital Charge Code |
41102742
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$718.34 |
| Max. Negotiated Rate |
$2,560.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,760.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$718.34
|
| Rate for Payer: Aetna Government |
$718.34
|
| Rate for Payer: Brighton Health Commercial |
$2,400.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,560.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,176.09
|
| Rate for Payer: Group Health Inc Commercial |
$1,600.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,120.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,600.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,600.06
|
|
|
EQ EMBO VARIX
|
Facility
|
OP
|
$3,200.13
|
|
|
Service Code
|
HCPCS 75894 TC
|
| Hospital Charge Code |
41107731
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$718.34 |
| Max. Negotiated Rate |
$2,560.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,760.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$718.34
|
| Rate for Payer: Aetna Government |
$718.34
|
| Rate for Payer: Brighton Health Commercial |
$2,400.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,560.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,176.09
|
| Rate for Payer: Group Health Inc Commercial |
$1,600.06
|
| Rate for Payer: Group Health Inc Medicare |
$1,120.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,600.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,600.06
|
|
|
EQ ENTIRE SPINE MYELOGRAM
|
Facility
|
IP
|
$2,062.03
|
|
|
Service Code
|
HCPCS 72270 TC
|
| Hospital Charge Code |
41102454
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$925.92
|
|
|
EQ ENTIRE SPINE MYELOGRAM
|
Facility
|
OP
|
$2,062.03
|
|
|
Service Code
|
HCPCS 72270 TC
|
| Hospital Charge Code |
41102454
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$648.14 |
| Max. Negotiated Rate |
$1,134.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,134.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$925.92
|
| Rate for Payer: Aetna Government |
$925.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$648.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$648.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$648.14
|
| Rate for Payer: Brighton Health Commercial |
$925.92
|
| Rate for Payer: Cash Price |
$925.92
|
| Rate for Payer: Cash Price |
$925.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$925.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$998.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$845.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$925.92
|
| Rate for Payer: EmblemHealth Commercial |
$648.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$824.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$925.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$824.07
|
| Rate for Payer: Group Health Inc Commercial |
$833.33
|
| Rate for Payer: Group Health Inc Medicare |
$833.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$925.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$833.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$925.92
|
| Rate for Payer: Healthfirst QHP |
$925.92
|
| Rate for Payer: Humana Medicare |
$944.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$925.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$925.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$925.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$740.74
|
| Rate for Payer: Wellcare Medicare |
$879.62
|
|
|
EQ EPIDURAL
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75872 TC
|
| Hospital Charge Code |
41102697
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$726.47
|
|
|
EQ EPIDURAL
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75872 TC
|
| Hospital Charge Code |
41102697
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$508.53 |
| Max. Negotiated Rate |
$1,438.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,050.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.47
|
| Rate for Payer: Aetna Government |
$726.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.53
|
| Rate for Payer: Brighton Health Commercial |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Cash Price |
$726.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,438.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,217.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$726.47
|
| Rate for Payer: EmblemHealth Commercial |
$508.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$617.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.56
|
| Rate for Payer: Group Health Inc Commercial |
$653.82
|
| Rate for Payer: Group Health Inc Medicare |
$653.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$653.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$726.47
|
| Rate for Payer: Healthfirst QHP |
$726.47
|
| Rate for Payer: Humana Medicare |
$741.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.18
|
| Rate for Payer: Wellcare Medicare |
$690.15
|
|
|
EQ E.R.C.P.
|
Facility
|
OP
|
$697.79
|
|
|
Service Code
|
HCPCS 74330 TC
|
| Hospital Charge Code |
41102012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.47 |
| Max. Negotiated Rate |
$558.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$383.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.47
|
| Rate for Payer: Aetna Government |
$100.47
|
| Rate for Payer: Brighton Health Commercial |
$523.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$558.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$474.50
|
| Rate for Payer: Group Health Inc Commercial |
$348.90
|
| Rate for Payer: Group Health Inc Medicare |
$244.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.90
|
|
|
EQ EXTREM ART BILATERAL
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75716 TC
|
| Hospital Charge Code |
41102675
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ EXTREM ART BILATERAL
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75716 TC
|
| Hospital Charge Code |
41102675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,580.26 |
| Max. Negotiated Rate |
$4,616.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,056.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,432.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$2,580.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,317.47
|
| Rate for Payer: Group Health Inc Medicare |
$3,317.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,317.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,686.08
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
EQ EXTREM ART UNILATERAL
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Hospital Charge Code |
41102677
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ EXTREM ART UNILATERAL
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Hospital Charge Code |
41102677
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,580.26 |
| Max. Negotiated Rate |
$4,616.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,056.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,432.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$2,580.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,317.47
|
| Rate for Payer: Group Health Inc Medicare |
$3,317.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,317.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,686.08
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
EQ EXTREMITY ANGIO - UNI LIM
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Hospital Charge Code |
41109574
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ EXTREMITY ANGIO - UNI LIM
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75710 TC
|
| Hospital Charge Code |
41109574
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,580.26 |
| Max. Negotiated Rate |
$4,616.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,056.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,432.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$2,580.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,317.47
|
| Rate for Payer: Group Health Inc Medicare |
$3,317.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,317.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,686.08
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
EQ EXTREM. VEN. BI
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75822 TC
|
| Hospital Charge Code |
41102596
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
EQ EXTREM. VEN. BI
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75822 TC
|
| Hospital Charge Code |
41102596
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,217.14 |
| Max. Negotiated Rate |
$2,717.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| 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: 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 |
$1,438.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,217.14
|
| 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 CHP/FHP/Medicaid |
$1,666.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,852.05
|
| 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
|
|
|
EQ EXTREM. VEN. UNI
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75820 TC
|
| Hospital Charge Code |
41102054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$954.82 |
| Max. Negotiated Rate |
$1,889.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,050.31
|
| 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: 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 |
$1,438.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,217.14
|
| 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 |
$954.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,666.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,852.05
|
| 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
|
|
|
EQ EXTREM. VEN. UNI
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75820 TC
|
| Hospital Charge Code |
41102054
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
EQ FALLOPIAN DILATION
|
Facility
|
OP
|
$1,147.78
|
|
|
Service Code
|
HCPCS 74742 TC
|
| Hospital Charge Code |
41108585
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$918.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$631.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.65
|
| Rate for Payer: Aetna Government |
$44.65
|
| Rate for Payer: Brighton Health Commercial |
$860.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$918.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$780.49
|
| Rate for Payer: Group Health Inc Commercial |
$573.89
|
| Rate for Payer: Group Health Inc Medicare |
$401.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$573.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$573.89
|
|
