|
EQ HEPATIC W/O HEMO EVAL.
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75891 TC
|
| Hospital Charge Code |
41102700
|
|
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/O HEMO EVAL.
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75891 TC
|
| Hospital Charge Code |
41102700
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ HIP ARTHROGRAM
|
Facility
|
IP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73525 TC
|
| Hospital Charge Code |
41102476
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$444.73
|
|
|
EQ HIP ARTHROGRAM
|
Facility
|
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73525 TC
|
| Hospital Charge Code |
41102476
|
|
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 HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 74740 TC
|
| Hospital Charge Code |
41102534
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74740 TC
|
| Hospital Charge Code |
41102534
|
|
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 ILIAC ANEURYSM ENDOVAS RPR
|
Facility
|
OP
|
$4,627.38
|
|
|
Service Code
|
HCPCS 34701 TC
|
| Hospital Charge Code |
41561858
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,351.35 |
| Max. Negotiated Rate |
$3,470.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,545.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,351.35
|
| Rate for Payer: Aetna Government |
$1,351.35
|
| Rate for Payer: Brighton Health Commercial |
$3,470.54
|
| 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: Group Health Inc Commercial |
$2,313.69
|
| Rate for Payer: Group Health Inc Medicare |
$1,619.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,313.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,313.69
|
|
|
EQ INJEC PROC-EVAL PERIT VEN SHUN
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 75809 TC
|
| Hospital Charge Code |
41107621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.00 |
| 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 |
$151.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$128.48
|
| 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 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
|
|
|
EQ INJEC PROC-EVAL PERIT VEN SHUN
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 75809 TC
|
| Hospital Charge Code |
41107621
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
EQ INJ OF CONT OR AIR INTO PERITO
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 74190 TC
|
| Hospital Charge Code |
41107619
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
EQ INJ OF CONT OR AIR INTO PERITO
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 74190 TC
|
| Hospital Charge Code |
41107619
|
|
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 INPT CONSLT LEAST COMPLX>20MIN
|
Facility
|
OP
|
$135.20
|
|
|
Service Code
|
HCPCS 99251 TC
|
| Hospital Charge Code |
41102829
|
|
Hospital Revenue Code
|
657
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$108.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.92
|
| Rate for Payer: Aetna Government |
$35.92
|
| Rate for Payer: Brighton Health Commercial |
$101.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.94
|
| Rate for Payer: Group Health Inc Commercial |
$67.60
|
| Rate for Payer: Group Health Inc Medicare |
$47.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.60
|
|
|
EQ INPT CONSLT MOD. COMPLEX>40MIN
|
Facility
|
OP
|
$211.45
|
|
|
Service Code
|
HCPCS 99252 TC
|
| Hospital Charge Code |
41102830
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$54.97 |
| Max. Negotiated Rate |
$169.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.97
|
| Rate for Payer: Aetna Government |
$54.97
|
| Rate for Payer: Brighton Health Commercial |
$158.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.79
|
| Rate for Payer: Group Health Inc Commercial |
$105.72
|
| Rate for Payer: Group Health Inc Medicare |
$74.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.72
|
| Rate for Payer: United Healthcare Commercial |
$105.72
|
|
|
EQ INPT CONSULT COMPREHENS.>80MIN
|
Facility
|
OP
|
$462.23
|
|
|
Service Code
|
HCPCS 99254 TC
|
| Hospital Charge Code |
41102832
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$122.72 |
| Max. Negotiated Rate |
$369.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$254.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.72
|
| Rate for Payer: Aetna Government |
$122.72
|
| Rate for Payer: Brighton Health Commercial |
$346.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$369.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$314.32
|
| Rate for Payer: Group Health Inc Commercial |
$231.12
|
| Rate for Payer: Group Health Inc Medicare |
$161.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.12
|
| Rate for Payer: United Healthcare Commercial |
$231.12
|
|
|
EQ INPT CONSULT MOST COMPLX>55MIN
|
Facility
|
OP
|
$320.35
|
|
|
Service Code
|
HCPCS 99253 TC
|
| Hospital Charge Code |
41102831
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$256.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.39
|
| Rate for Payer: Aetna Government |
$84.39
|
| Rate for Payer: Brighton Health Commercial |
$240.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$256.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$217.84
|
| Rate for Payer: Group Health Inc Commercial |
$160.18
|
| Rate for Payer: Group Health Inc Medicare |
$112.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.18
|
| Rate for Payer: United Healthcare Commercial |
$160.18
|
|
|
EQ INTRALUM. FB REM ESOPH
|
Facility
|
OP
|
$650.40
|
|
|
Service Code
|
HCPCS 74235 TC
|
| Hospital Charge Code |
41102703
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$520.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.05
|
| Rate for Payer: Aetna Government |
$94.05
|
| 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 IVC
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75825 TC
|
| Hospital Charge Code |
41102598
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ IVC
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75825 TC
|
| Hospital Charge Code |
41102598
|
|
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 KNEE ARTHROGRAM
|
Facility
|
IP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73580 TC
|
| Hospital Charge Code |
41102324
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$444.73
|
|
|
EQ KNEE ARTHROGRAM
|
Facility
|
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73580 TC
|
| Hospital Charge Code |
41102324
|
|
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 LAMINECTOMY O.R.
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 72100 TC
|
| Hospital Charge Code |
41102254
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.27 |
| 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 |
$90.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.27
|
| 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 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
|
|
|
EQ LAMINECTOMY O.R.
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 72100 TC
|
| Hospital Charge Code |
41102254
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
EQ LARYNGOGRAM
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41102036
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
EQ LARYNGOGRAM
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41102036
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.56 |
| 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 |
$90.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.27
|
| 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 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
|
|
|
EQ LITHOTRIPSY - ESWL
|
Facility
|
IP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 50590 TC
|
| Hospital Charge Code |
41109868
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,031.47
|
|
