|
EQ TRANSHEPATIC PORTO W/HEMO
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 75885 TC
|
| Hospital Charge Code |
41107473
|
|
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 TRANSJUGULAR LIVER BIOPSY
|
Facility
|
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 77002 TC
|
| Hospital Charge Code |
41107654
|
|
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 TRANSLUM. ADD'L PER ART
|
Facility
|
OP
|
$5,248.77
|
|
|
Service Code
|
HCPCS 37233 TC
|
| Hospital Charge Code |
41102776
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,592.77 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,592.77
|
| Rate for Payer: Aetna Government |
$1,592.77
|
| Rate for Payer: Brighton Health Commercial |
$3,936.58
|
| 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 |
$2,624.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,837.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.38
|
|
|
EQ TRANSLUM. ADD'L VISC ART
|
Facility
|
OP
|
$5,248.77
|
|
|
Service Code
|
HCPCS 0235T TC
|
| Hospital Charge Code |
41102777
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,837.07 |
| Max. Negotiated Rate |
$4,199.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,162.54
|
| Rate for Payer: Aetna Government |
$2,162.54
|
| Rate for Payer: Brighton Health Commercial |
$3,936.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,199.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,569.16
|
| Rate for Payer: Group Health Inc Commercial |
$2,624.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,837.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.38
|
|
|
EQ TRANSLUM AORTA
|
Facility
|
OP
|
$5,248.77
|
|
|
Service Code
|
HCPCS 0235T TC
|
| Hospital Charge Code |
41102767
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,837.07 |
| Max. Negotiated Rate |
$4,199.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,162.54
|
| Rate for Payer: Aetna Government |
$2,162.54
|
| Rate for Payer: Brighton Health Commercial |
$3,936.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,199.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,569.16
|
| Rate for Payer: Group Health Inc Commercial |
$2,624.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,837.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.38
|
|
|
EQ TRANSLUM. FEM-POP ARTERY
|
Facility
|
IP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 37227 TC
|
| Hospital Charge Code |
41102771
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$20,278.00
|
|
|
EQ TRANSLUM. FEM-POP ARTERY
|
Facility
|
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 37227 TC
|
| Hospital Charge Code |
41102771
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$36,208.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14,194.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14,194.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14,194.60
|
| Rate for Payer: Brighton Health Commercial |
$36,208.64
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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 |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$20,278.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$20,278.00
|
| Rate for Payer: Group Health Inc Medicare |
$20,278.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Humana Medicare |
$20,683.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
EQ TRANSLUM. TIBIO TK. ART
|
Facility
|
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37225 TC
|
| Hospital Charge Code |
41102775
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$20,683.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14,194.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14,194.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14,194.60
|
| Rate for Payer: Brighton Health Commercial |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| 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 |
$20,278.00
|
| Rate for Payer: EmblemHealth Commercial |
$14,194.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| Rate for Payer: Group Health Inc Commercial |
$18,250.20
|
| Rate for Payer: Group Health Inc Medicare |
$18,250.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Humana Medicare |
$20,683.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
EQ TRANSLUM. TIBIO TK. ART
|
Facility
|
IP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 37225 TC
|
| Hospital Charge Code |
41102775
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$20,278.00
|
|
|
EQ TRLUML PERIP ATHRC ILIAC ART
|
Facility
|
IP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 0238T
|
| Hospital Charge Code |
41102769
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$20,278.00
|
|
|
EQ TRLUML PERIP ATHRC ILIAC ART
|
Facility
|
OP
|
$48,278.18
|
|
|
Service Code
|
HCPCS 0238T
|
| Hospital Charge Code |
41102769
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$24,139.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,278.00
|
| Rate for Payer: Aetna Government |
$20,278.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14,194.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14,194.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14,194.60
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Cash Price |
$20,278.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,278.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,236.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18,047.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,278.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18,047.42
|
| 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 |
$24,139.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,278.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,236.30
|
| Rate for Payer: Healthfirst QHP |
$20,278.00
|
| Rate for Payer: Humana Medicare |
$20,683.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20,278.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,278.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,278.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,278.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16,222.40
|
| Rate for Payer: Wellcare Medicare |
$19,264.10
|
|
|
EQ TRLUML PERIP ATHRC RENAL ART
|
Facility
|
IP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
41102763
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$12,721.98
|
|
|
EQ TRLUML PERIP ATHRC RENAL ART
|
Facility
|
OP
|
$30,010.30
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
41102763
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$15,005.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,721.98
|
| Rate for Payer: Aetna Government |
$12,721.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,905.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,905.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,905.39
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Cash Price |
$12,721.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,721.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,813.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,322.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,721.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,322.56
|
| 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 |
$15,005.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,721.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,813.68
|
| Rate for Payer: Healthfirst QHP |
$12,721.98
|
| Rate for Payer: Humana Medicare |
$12,976.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12,721.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,721.98
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,721.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,721.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10,177.58
|
| Rate for Payer: Wellcare Medicare |
$12,085.88
|
|
|
EQ TRLUML PERIP ATHRC VISCERAL
|
Facility
|
OP
|
$5,248.77
|
|
|
Service Code
|
HCPCS 0235T TC
|
| Hospital Charge Code |
41102765
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$2,886.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,886.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,162.54
|
| Rate for Payer: Aetna Government |
$2,162.54
|
| 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 |
$2,624.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.38
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
EQUIP. CHGE CONT. VENT.
|
Facility
|
OP
|
$49.61
|
|
|
Service Code
|
HCPCS A4618
|
| Hospital Charge Code |
40307350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$39.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.41
|
| Rate for Payer: Aetna Government |
$5.41
|
| Rate for Payer: Brighton Health Commercial |
$37.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.73
|
| Rate for Payer: Group Health Inc Commercial |
$24.80
|
| Rate for Payer: Group Health Inc Medicare |
$17.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.80
|
|
|
EQ URETHROCYSTOGRAM, RETRO
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74450 TC
|
| Hospital Charge Code |
41107480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.36 |
| 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 |
$352.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$298.26
|
| 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 URETHROCYSTOGRAM, RETRO
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 74450 TC
|
| Hospital Charge Code |
41107480
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ URETHROCYSTOGRAM, VOID
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 74455 TC
|
| Hospital Charge Code |
41107481
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EQ URETHROCYSTOGRAM, VOID
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 74455 TC
|
| Hospital Charge Code |
41107481
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.36 |
| 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 |
$352.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$298.26
|
| 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 UROGRAPHY ANTEGRADE RS&I
|
Facility
|
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41102731
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.26 |
| 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 |
$352.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$298.26
|
| 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 UROGRAPHY ANTEGRADE RS&I
|
Facility
|
IP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41102731
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$444.73
|
|
|
EQ UROGRAPHY ANTEGRDE RS&I
|
Facility
|
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41107642
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.26 |
| 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 |
$352.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$298.26
|
| 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 UROGRAPHY ANTEGRDE RS&I
|
Facility
|
IP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41107642
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$444.73
|
|
|
EQ UROGRAPHY ANTGRADE RS&I
|
Facility
|
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41102524
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.26 |
| Max. Negotiated Rate |
$627.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$627.55
|
| 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 |
$352.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$298.26
|
| 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 |
$570.50
|
| 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 UROGRAPHY ANTGRADE RS&I
|
Facility
|
IP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41102524
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$444.73
|
|
