|
EQ SIALOGRAM
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 70390 TC
|
| Hospital Charge Code |
41102180
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ SIALOGRAM W/DUCT DIL
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 70390 TC
|
| Hospital Charge Code |
41102820
|
|
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 SIALOGRAM W/DUCT DIL
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 70390 TC
|
| Hospital Charge Code |
41102820
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ SINUS OR JUGULAR
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75860 TC
|
| Hospital Charge Code |
41102695
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,217.14 |
| 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 |
$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 |
$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 SINUS OR JUGULAR
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75860 TC
|
| Hospital Charge Code |
41102695
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ SPINAL ART. SELECTIVE
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75705 TC
|
| Hospital Charge Code |
41102827
|
|
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 SPINAL ART. SELECTIVE
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75705 TC
|
| Hospital Charge Code |
41102827
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
EQ SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75810 TC
|
| Hospital Charge Code |
41107686
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75810 TC
|
| Hospital Charge Code |
41107686
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,470.14 |
| Max. Negotiated Rate |
$4,056.10 |
| 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 |
$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 |
$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 SUPERIOR SAGITTAL SINUS
|
Facility
|
IP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75870 TC
|
| Hospital Charge Code |
41102696
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
EQ SUPERIOR SAGITTAL SINUS
|
Facility
|
OP
|
$4,940.28
|
|
|
Service Code
|
HCPCS 75870 TC
|
| Hospital Charge Code |
41102696
|
|
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 SVC
|
Facility
|
OP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75827 TC
|
| Hospital Charge Code |
41102600
|
|
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 SVC
|
Facility
|
IP
|
$1,909.65
|
|
|
Service Code
|
HCPCS 75827 TC
|
| Hospital Charge Code |
41102600
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$1,852.05
|
|
|
EQ TANKOFF CATH. REPOSITION
|
Facility
|
OP
|
$453.64
|
|
|
Service Code
|
HCPCS 75989 TC
|
| Hospital Charge Code |
41107491
|
|
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 THORACENTESIS, W/INSERT OF TUB
|
Facility
|
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41107614
|
|
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 THORACIC AORTOGRAM
|
Facility
|
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75605 TC
|
| Hospital Charge Code |
41102536
|
|
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 THORACIC AORTOGRAM
|
Facility
|
IP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75605 TC
|
| Hospital Charge Code |
41102536
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$6,354.94
|
|
|
EQ THORACIC MYELOGRAM
|
Facility
|
OP
|
$2,062.03
|
|
|
Service Code
|
HCPCS 72255 TC
|
| Hospital Charge Code |
41102450
|
|
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 THORACIC MYELOGRAM
|
Facility
|
IP
|
$2,062.03
|
|
|
Service Code
|
HCPCS 72255 TC
|
| Hospital Charge Code |
41102450
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$925.92
|
|
|
EQ TMJ ARTHOGRAM
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 70332 TC
|
| Hospital Charge Code |
41561914
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ TMJ ARTHOGRAM
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 70332 TC
|
| Hospital Charge Code |
41561914
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$2,915.00 |
| 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 |
$529.37
|
| Rate for Payer: Cash Price |
$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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| 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 |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| 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 TRANSCATHETER BILLIARY BIOPSY
|
Facility
|
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41107650
|
|
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 TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$1,528.75
|
|
|
Service Code
|
HCPCS 75970 TC
|
| Hospital Charge Code |
41107694
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$332.66 |
| Max. Negotiated Rate |
$1,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$840.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$332.66
|
| Rate for Payer: Aetna Government |
$332.66
|
| Rate for Payer: Brighton Health Commercial |
$1,146.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,223.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,039.55
|
| Rate for Payer: Group Health Inc Commercial |
$764.38
|
| Rate for Payer: Group Health Inc Medicare |
$535.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$764.38
|
|
|
EQ TRANSCERV. CATH FALL. TB
|
Facility
|
OP
|
$1,147.78
|
|
|
Service Code
|
HCPCS 74742 TC
|
| Hospital Charge Code |
41107490
|
|
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
|
|
|
EQ TRANSHEPATIC PORTO W/HEMO
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75885 TC
|
| Hospital Charge Code |
41107473
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
