|
EQ OUTPT CONS. MOD COMPLX - 30MIN
|
Facility
|
OP
|
$395.39
|
|
|
Service Code
|
HCPCS 99242 TC
|
| Hospital Charge Code |
41108610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$217.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.50
|
| Rate for Payer: Aetna Government |
$66.50
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$197.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.70
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
EQ OUTPT CONS. MOST COMPLEX-60MIN
|
Facility
|
OP
|
$528.33
|
|
|
Service Code
|
HCPCS 99244 TC
|
| Hospital Charge Code |
41108611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.64 |
| Max. Negotiated Rate |
$290.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.64
|
| Rate for Payer: Aetna Government |
$135.64
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$264.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.16
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
EQ PELVIC
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75736 TC
|
| Hospital Charge Code |
41102584
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,432.09 |
| Max. Negotiated Rate |
$7,656.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,656.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,448.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,448.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,448.46
|
| Rate for Payer: Brighton Health Commercial |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$4,448.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$5,719.45
|
| Rate for Payer: Group Health Inc Medicare |
$5,719.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5,719.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,354.94
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Humana Medicare |
$6,482.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
EQ PELVIC
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75736 TC
|
| Hospital Charge Code |
41102584
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
EQ PERC DIAL BIL STRICT W/O STENT
|
Facility
|
OP
|
$1,116.80
|
|
|
Service Code
|
HCPCS 74363 TC
|
| Hospital Charge Code |
41107670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$893.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$614.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.88
|
| Rate for Payer: Aetna Government |
$64.88
|
| Rate for Payer: Brighton Health Commercial |
$837.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$893.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$759.42
|
| Rate for Payer: Group Health Inc Commercial |
$558.40
|
| Rate for Payer: Group Health Inc Medicare |
$390.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.40
|
|
|
EQ PERC DILA BIL STRICT W STENT
|
Facility
|
OP
|
$1,116.80
|
|
|
Service Code
|
HCPCS 74363 TC
|
| Hospital Charge Code |
41107672
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$893.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$614.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.88
|
| Rate for Payer: Aetna Government |
$64.88
|
| Rate for Payer: Brighton Health Commercial |
$837.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$893.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$759.42
|
| Rate for Payer: Group Health Inc Commercial |
$558.40
|
| Rate for Payer: Group Health Inc Medicare |
$390.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.40
|
|
|
EQ PERC. DIL. BIL W/STENT
|
Facility
|
OP
|
$1,116.80
|
|
|
Service Code
|
HCPCS 74363 TC
|
| Hospital Charge Code |
41102719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$893.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$614.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.88
|
| Rate for Payer: Aetna Government |
$64.88
|
| Rate for Payer: Brighton Health Commercial |
$837.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$893.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$759.42
|
| Rate for Payer: Group Health Inc Commercial |
$558.40
|
| Rate for Payer: Group Health Inc Medicare |
$390.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.40
|
|
|
EQ PERC. DRAIN. STENT. URETE
|
Facility
|
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 50433 TC
|
| Hospital Charge Code |
41102530
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,888.00 |
| Max. Negotiated Rate |
$4,571.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,822.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,822.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,822.03
|
| Rate for Payer: Brighton Health Commercial |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$2,822.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$3,628.32
|
| Rate for Payer: Group Health Inc Medicare |
$3,628.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Humana Medicare |
$4,112.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
EQ PERC. DRAIN. STENT. URETE
|
Facility
|
IP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 50433 TC
|
| Hospital Charge Code |
41102530
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$4,031.47
|
|
|
EQ PERC. PLACE ENTERCLYSIS
|
Facility
|
OP
|
$697.79
|
|
|
Service Code
|
HCPCS 74355 TC
|
| Hospital Charge Code |
41102520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.98 |
| Max. Negotiated Rate |
$558.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$383.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.98
|
| Rate for Payer: Aetna Government |
$84.98
|
| 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 PERC. PLACE IVC FILTER
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37191 TC
|
| Hospital Charge Code |
41102779
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$6,960.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,354.94
|
| Rate for Payer: Aetna Government |
$6,354.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,448.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,448.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,448.46
|
| Rate for Payer: Brighton Health Commercial |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,354.94
|
| 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 |
$6,354.94
|
| Rate for Payer: EmblemHealth Commercial |
$4,448.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,401.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,655.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,354.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,655.90
|
| Rate for Payer: Group Health Inc Commercial |
$5,719.45
|
| Rate for Payer: Group Health Inc Medicare |
$5,719.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,354.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,401.70
|
| Rate for Payer: Healthfirst QHP |
$6,354.94
|
| Rate for Payer: Humana Medicare |
$6,482.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,354.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,354.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,354.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,083.95
|
| Rate for Payer: Wellcare Medicare |
$6,037.19
|
|
|
EQ PERC. PLACE IVC FILTER
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 37191 TC
|
| Hospital Charge Code |
41102779
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
EQ PERC. TRANS. RETR. F.B.
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37197 TC
|
| Hospital Charge Code |
41102610
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ PERC. TRANS. RETR. F.B.
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37197 TC
|
| Hospital Charge Code |
41102610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$6,295.15
|
| Rate for Payer: Cash Price |
$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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| 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 Commercial |
$1,835.00
|
| 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 PERCUTANEOUS CHOLECYSTOSTOMY
|
Facility
|
OP
|
$453.64
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
41547674
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$362.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$249.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.95
|
| Rate for Payer: Aetna Government |
$64.95
|
| Rate for Payer: Brighton Health Commercial |
$340.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$362.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$308.48
|
| Rate for Payer: Group Health Inc Commercial |
$226.82
|
| Rate for Payer: Group Health Inc Medicare |
$158.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.82
|
|
|
EQ PER. DIL. BIL W/O STENT
|
Facility
|
OP
|
$1,116.80
|
|
|
Service Code
|
HCPCS 74363 TC
|
| Hospital Charge Code |
41102717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$893.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$614.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.88
|
| Rate for Payer: Aetna Government |
$64.88
|
| Rate for Payer: Brighton Health Commercial |
$837.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$893.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$759.42
|
| Rate for Payer: Group Health Inc Commercial |
$558.40
|
| Rate for Payer: Group Health Inc Medicare |
$390.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.40
|
|
|
EQ PERITO, ABD PARACENTESIS
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 74190 TC
|
| Hospital Charge Code |
41107618
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
EQ PERITO, ABD PARACENTESIS
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 74190 TC
|
| Hospital Charge Code |
41107618
|
|
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 PORTAL VENOGRAM, W/PRESSURES
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75885 TC
|
| Hospital Charge Code |
41107727
|
|
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 PORTAL VENOGRAM, W/PRESSURES
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75885 TC
|
| Hospital Charge Code |
41107727
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ PULMONARY BI
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75743 TC
|
| Hospital Charge Code |
41102588
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ PULMONARY BI
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75743 TC
|
| Hospital Charge Code |
41102588
|
|
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 PULMONARY NON-SELECTIV
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75746 TC
|
| Hospital Charge Code |
41102590
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ PULMONARY NON-SELECTIV
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75746 TC
|
| Hospital Charge Code |
41102590
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,217.14 |
| Max. Negotiated Rate |
$3,759.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.15
|
| 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 |
$1,438.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,217.14
|
| 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 |
$2,470.14
|
| 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 PULMONARY UNI
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75741 TC
|
| Hospital Charge Code |
41102586
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
