|
SICKLE CELL SCREEN
|
Facility
OP
|
$13.78
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
40621555
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.51
|
| Rate for Payer: Aetna Government |
$5.51
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.51
|
| Rate for Payer: EmblemHealth Commercial |
$5.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.90
|
| Rate for Payer: Group Health Inc Commercial |
$5.51
|
| Rate for Payer: Group Health Inc Medicare |
$5.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.51
|
| Rate for Payer: Healthfirst QHP |
$5.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.41
|
| Rate for Payer: Wellcare Medicare |
$4.96
|
|
|
SIENTRA BREAST EXPANDER
|
Facility
IP
|
$2,590.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40005328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.00 |
| Max. Negotiated Rate |
$1,295.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,295.00
|
|
|
SIENTRA BREAST EXPANDER
|
Facility
OP
|
$2,590.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40005328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.32 |
| Max. Negotiated Rate |
$2,719.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,424.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.32
|
| Rate for Payer: Aetna Government |
$402.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,295.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,489.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,719.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,295.00
|
| Rate for Payer: Group Health Inc Medicare |
$906.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,295.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,683.50
|
|
|
SIGMOIDOSCOPE DISPO KLEENSPEC
|
Facility
OP
|
$17.93
|
|
| Hospital Charge Code |
64903014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$14.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.96
|
| Rate for Payer: Aetna Government |
$8.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.19
|
| Rate for Payer: Group Health Inc Commercial |
$8.96
|
| Rate for Payer: Group Health Inc Medicare |
$6.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.96
|
|
|
SIGMOIDOSCOPE DISPOSABLE KLEENSPE
|
Facility
OP
|
$6.70
|
|
| Hospital Charge Code |
40200624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.56
|
| Rate for Payer: Group Health Inc Commercial |
$3.35
|
| Rate for Payer: Group Health Inc Medicare |
$2.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.35
|
|
|
SIGMOIDOSCOPY
|
Facility
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
41118120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$61.37 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| Rate for Payer: Group Health Inc Commercial |
$1,056.92
|
| Rate for Payer: Group Health Inc Medicare |
$1,056.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.38
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
SIGMOIDOSCOPY AND BIOPSY
|
Facility
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45331
|
| Hospital Charge Code |
41114206
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$77.62 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| Rate for Payer: Group Health Inc Commercial |
$1,056.92
|
| Rate for Payer: Group Health Inc Medicare |
$1,056.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.38
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
SIGMOIDOSCOPY AND POLYPECTOMY
|
Facility
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45333
|
| Hospital Charge Code |
41114207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$102.33 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| Rate for Payer: Group Health Inc Commercial |
$1,056.92
|
| Rate for Payer: Group Health Inc Medicare |
$1,056.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.38
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
SIGMOIDOSCOPY/HEMORRHOIDECTOMY
|
Facility
OP
|
$7,099.93
|
|
|
Service Code
|
HCPCS 46250
|
| Hospital Charge Code |
40011220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$360.28 |
| Max. Negotiated Rate |
$3,549.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| 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 |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,549.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$400.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
SIGMOIDOSCOPY W CONTROL BLEEDING
|
Facility
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 45334
|
| Hospital Charge Code |
41118917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,364.66
|
| Rate for Payer: Aetna Government |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,364.66
|
| 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 |
$1,364.66
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,364.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.55
|
| Rate for Payer: Group Health Inc Commercial |
$1,364.66
|
| Rate for Payer: Group Health Inc Medicare |
$1,364.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,159.96
|
| Rate for Payer: Healthfirst QHP |
$1,364.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,364.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,364.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,091.73
|
| Rate for Payer: Wellcare Medicare |
$1,296.43
|
|
|
SIGMOIDOSCOPY W SUBMUCOSAL INJ
|
Facility
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45335
|
| Hospital Charge Code |
41114208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| Rate for Payer: Group Health Inc Commercial |
$1,056.92
|
| Rate for Payer: Group Health Inc Medicare |
$1,056.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.38
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
SIGMOIDOSCOPY W/TUMOR REMOVAL
|
Facility
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 45338
|
| Hospital Charge Code |
41118915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$129.41 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,364.66
|
| Rate for Payer: Aetna Government |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,364.66
|
| 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 |
$1,364.66
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,364.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.55
|
| Rate for Payer: Group Health Inc Commercial |
$1,364.66
|
| Rate for Payer: Group Health Inc Medicare |
$1,364.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,159.96
|
| Rate for Payer: Healthfirst QHP |
$1,364.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,364.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,364.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,091.73
|
| Rate for Payer: Wellcare Medicare |
$1,296.43
|
|
|
SIGMOIDOSCOPY W/ULTRASOUND
|
Facility
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45341
|
| Hospital Charge Code |
41112833
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$132.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| Rate for Payer: Group Health Inc Commercial |
$1,056.92
|
| Rate for Payer: Group Health Inc Medicare |
$1,056.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.38
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
SIGMOIDOSCOPY W/US GUIDE
|
Facility
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 45342
|
| Hospital Charge Code |
41118924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$184.74 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,364.66
|
| Rate for Payer: Aetna Government |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Cash Price |
$1,364.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,364.66
|
| 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 |
$1,364.66
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,364.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.55
|
| Rate for Payer: Group Health Inc Commercial |
$1,364.66
|
| Rate for Payer: Group Health Inc Medicare |
$1,364.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,159.96
|
| Rate for Payer: Healthfirst QHP |
$1,364.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,364.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,364.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,091.73
|
| Rate for Payer: Wellcare Medicare |
$1,296.43
|
|
|
SIGMOID RESECTION
|
Facility
OP
|
$4,205.72
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
40011050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,472.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,313.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,646.66
|
| Rate for Payer: Aetna Government |
$1,646.66
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,597.79
|
| Rate for Payer: Group Health Inc Commercial |
$2,102.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,472.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,102.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,102.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,775.32
|
|
|
SIGMOIDSCOPY
|
Facility
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
40000475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$61.37 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| Rate for Payer: Group Health Inc Commercial |
$1,056.92
|
| Rate for Payer: Group Health Inc Medicare |
$1,056.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.38
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
SIGMOID UNIT DISPOSABLE
|
Facility
OP
|
$4.25
|
|
| Hospital Charge Code |
40000335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.89
|
| Rate for Payer: Group Health Inc Commercial |
$2.12
|
| Rate for Payer: Group Health Inc Medicare |
$1.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.12
|
|
|
SIGNAL AVERAGE EKG
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 93278 TC
|
| Hospital Charge Code |
40801500
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.30
|
| Rate for Payer: Aetna Government |
$83.30
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.82
|
| Rate for Payer: Group Health Inc Commercial |
$83.30
|
| Rate for Payer: Group Health Inc Medicare |
$58.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.91
|
|
|
SIGN LANGUAGE/ORAL - PER 15 MIN
|
Facility
OP
|
$11.00
|
|
|
Service Code
|
HCPCS T1013
|
| Hospital Charge Code |
30305807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$1,446.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Amida Care Medicaid |
$14.46
|
| 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: Fidelis CHP/HARP/Medicaid |
$1,446.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.18
|
| 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 |
$14.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.46
|
| Rate for Payer: Healthfirst Essential Plan |
$32.54
|
| Rate for Payer: Healthfirst QHP |
$14.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.46
|
| Rate for Payer: SOMOS Essential |
$32.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.46
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
IP
|
$27,262.88
|
|
|
Service Code
|
MS-DRG 555
|
| Min. Negotiated Rate |
$11,996.40 |
| Max. Negotiated Rate |
$27,262.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,628.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,728.31
|
| Rate for Payer: Aetna Government |
$26,728.31
|
| Rate for Payer: Brighton Health Commercial |
$20,285.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,262.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,159.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,937.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,391.89
|
| Rate for Payer: EmblemHealth Commercial |
$11,996.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,728.31
|
| Rate for Payer: Group Health Inc Commercial |
$26,728.31
|
| Rate for Payer: Group Health Inc Medicare |
$26,728.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,728.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,428.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,728.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,728.31
|
| Rate for Payer: Wellcare Medicare |
$25,391.89
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC
|
Facility
IP
|
$19,135.30
|
|
|
Service Code
|
MS-DRG 556
|
| Min. Negotiated Rate |
$7,069.23 |
| Max. Negotiated Rate |
$19,135.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,155.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,760.10
|
| Rate for Payer: Aetna Government |
$18,760.10
|
| Rate for Payer: Brighton Health Commercial |
$11,953.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,135.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,236.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,748.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,822.10
|
| Rate for Payer: EmblemHealth Commercial |
$7,069.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,760.10
|
| Rate for Payer: Group Health Inc Commercial |
$18,760.10
|
| Rate for Payer: Group Health Inc Medicare |
$18,760.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,760.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,723.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,760.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,760.10
|
| Rate for Payer: Wellcare Medicare |
$17,822.10
|
|
|
SIGNS AND SYMPTOMS WITH MCC
|
Facility
IP
|
$25,177.95
|
|
|
Service Code
|
MS-DRG 947
|
| Min. Negotiated Rate |
$10,732.50 |
| Max. Negotiated Rate |
$25,177.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,454.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,684.26
|
| Rate for Payer: Aetna Government |
$24,684.26
|
| Rate for Payer: Brighton Health Commercial |
$18,148.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,177.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,613.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,836.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,450.05
|
| Rate for Payer: EmblemHealth Commercial |
$10,732.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,684.26
|
| Rate for Payer: Group Health Inc Commercial |
$24,684.26
|
| Rate for Payer: Group Health Inc Medicare |
$24,684.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,684.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,478.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,684.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,684.26
|
| Rate for Payer: Wellcare Medicare |
$23,450.05
|
|
|
SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
IP
|
$18,804.33
|
|
|
Service Code
|
MS-DRG 948
|
| Min. Negotiated Rate |
$6,868.58 |
| Max. Negotiated Rate |
$18,804.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,810.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,435.62
|
| Rate for Payer: Aetna Government |
$18,435.62
|
| Rate for Payer: Brighton Health Commercial |
$11,614.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,804.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,832.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,415.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,513.84
|
| Rate for Payer: EmblemHealth Commercial |
$6,868.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,435.62
|
| Rate for Payer: Group Health Inc Commercial |
$18,435.62
|
| Rate for Payer: Group Health Inc Medicare |
$18,435.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,435.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,572.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,435.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,435.62
|
| Rate for Payer: Wellcare Medicare |
$17,513.84
|
|
|
SILDENAFIL 20MG
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
41648020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.00
|
| Rate for Payer: Aetna Government |
$19.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.84
|
| Rate for Payer: Group Health Inc Commercial |
$19.00
|
| Rate for Payer: Group Health Inc Medicare |
$13.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.70
|
|
|
SILDENAFIL 20MG
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
41658020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.00
|
| Rate for Payer: Aetna Government |
$19.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.84
|
| Rate for Payer: Group Health Inc Commercial |
$19.00
|
| Rate for Payer: Group Health Inc Medicare |
$13.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.70
|
|
