|
EQ FISTULA OR SINUS TRACT STUDY
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Hospital Charge Code |
41107627
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$389.43 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$460.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$389.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$446.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$542.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$574.17
|
| Rate for Payer: Group Health Inc Medicare |
$574.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$637.97
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
EQ FISTULA OR SINUS TRACT STUDY
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Hospital Charge Code |
41107627
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
EQ FISTULA/SINUS TRACT
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Hospital Charge Code |
41102136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$389.43 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$460.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$389.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$446.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$542.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$574.17
|
| Rate for Payer: Group Health Inc Medicare |
$574.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$637.97
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
EQ FISTULA/SINUS TRACT
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Hospital Charge Code |
41102136
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
EQ FL GUID REMV VEN ACC DEV
|
Facility
|
OP
|
$329.14
|
|
|
Service Code
|
HCPCS 77001 TC
|
| Hospital Charge Code |
41109856
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$263.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.17
|
| Rate for Payer: Aetna Government |
$40.17
|
| Rate for Payer: Brighton Health Commercial |
$246.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$263.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$223.82
|
| Rate for Payer: Group Health Inc Commercial |
$164.57
|
| Rate for Payer: Group Health Inc Medicare |
$115.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.57
|
|
|
EQ FLUORO FOR BIOP/ASP
|
Facility
|
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41102632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$915.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.91
|
| Rate for Payer: Aetna Government |
$50.91
|
| 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
|
|
|
EQ FLUORO GD VASC ACC
|
Facility
|
OP
|
$329.14
|
|
|
Service Code
|
HCPCS 77001 TC
|
| Hospital Charge Code |
41109851
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$263.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.17
|
| Rate for Payer: Aetna Government |
$40.17
|
| Rate for Payer: Brighton Health Commercial |
$246.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$263.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$223.82
|
| Rate for Payer: Group Health Inc Commercial |
$164.57
|
| Rate for Payer: Group Health Inc Medicare |
$115.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.57
|
|
|
EQ FLUORO MORE THAN 1 HOUR
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Hospital Charge Code |
41102638
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ FLUORO MORE THAN 1 HOUR
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Hospital Charge Code |
41102638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$388.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$141.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$198.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$255.03
|
| Rate for Payer: Group Health Inc Medicare |
$255.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.37
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
EQ FLUORO UP TO 1 HOUR
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Hospital Charge Code |
41102630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$388.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$141.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$198.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$255.03
|
| Rate for Payer: Group Health Inc Medicare |
$255.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.37
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
EQ FLUORO UP TO 1 HOUR
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Hospital Charge Code |
41102630
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ FLURO. GUID INTRTHOR LE
|
Facility
|
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41102418
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$915.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.91
|
| Rate for Payer: Aetna Government |
$50.91
|
| 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
|
|
|
EQ GALACTOGRAM
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 77053 TC
|
| Hospital Charge Code |
41102666
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ GALACTOGRAM
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 77053 TC
|
| Hospital Charge Code |
41102666
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$460.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$460.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$389.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$198.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$255.03
|
| Rate for Payer: Group Health Inc Medicare |
$255.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.37
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
EQ GALACTOGRAM MULTIPLE
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 77054 TC
|
| Hospital Charge Code |
41102668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$460.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$460.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$389.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$198.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$255.03
|
| Rate for Payer: Group Health Inc Medicare |
$255.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.37
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
EQ GALACTOGRAM MULTIPLE
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 77054 TC
|
| Hospital Charge Code |
41102668
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ GASTROSTOMY CTH CHECK
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Hospital Charge Code |
41107477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$389.43 |
| Max. Negotiated Rate |
$802.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$460.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$389.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$446.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$542.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$574.17
|
| Rate for Payer: Group Health Inc Medicare |
$574.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$637.97
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
EQ GASTROSTOMY CTH CHECK
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76080 TC
|
| Hospital Charge Code |
41107477
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
EQ GI TUBE CHANGE W/CONTRAST
|
Facility
|
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 75984 TC
|
| Hospital Charge Code |
41108586
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.93 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.93
|
| Rate for Payer: Aetna Government |
$55.93
|
| Rate for Payer: Brighton Health Commercial |
$487.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.27
|
| 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
|
|
|
EQ HEPATIC VENOGRAM W/O PRESSURES
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75891 TC
|
| Hospital Charge Code |
41107724
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ HEPATIC VENOGRAM W/O PRESSURES
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75891 TC
|
| Hospital Charge Code |
41107724
|
|
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 HEPATIC VENOGRAM W/PRESSURES
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75889 TC
|
| Hospital Charge Code |
41107725
|
|
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 HEPATIC VENOGRAM W/PRESSURES
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75889 TC
|
| Hospital Charge Code |
41107725
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ HEPATIC W/HEMO EVAL.
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75889 TC
|
| Hospital Charge Code |
41102699
|
|
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 HEPATIC W/HEMO EVAL.
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75889 TC
|
| Hospital Charge Code |
41102699
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
