|
UPPERFACE/MIDFACE IN-SITU PLATE
|
Facility
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,207.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$632.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$575.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$661.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,207.50
|
| Rate for Payer: Group Health Inc Commercial |
$575.00
|
| Rate for Payer: Group Health Inc Medicare |
$402.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$575.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$575.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.50
|
|
|
UPPER GI ENDOSCOPY/TUMOR
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
40019862
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.05 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$185.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
UPPER GI ENDOSCOPY/TUMOR BY SNARE
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
40014231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
UPPER GI ENDOSCOPY W CONTROL BLEE
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43255
|
| Hospital Charge Code |
40019665
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
UPPER GI SCOPE DILATE STRICT
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
41114204
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$190.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
UPPER GI SCOPE W SUBMUCOSAL INJ
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43236
|
| Hospital Charge Code |
41114203
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$146.98 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
IP
|
$30,667.51
|
|
|
Service Code
|
MS-DRG 256
|
| Min. Negotiated Rate |
$13,980.78 |
| Max. Negotiated Rate |
$30,667.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,177.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,066.19
|
| Rate for Payer: Aetna Government |
$30,066.19
|
| Rate for Payer: Brighton Health Commercial |
$23,775.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,667.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,315.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,367.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,562.88
|
| Rate for Payer: EmblemHealth Commercial |
$14,060.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,066.19
|
| Rate for Payer: Group Health Inc Commercial |
$30,066.19
|
| Rate for Payer: Group Health Inc Medicare |
$30,066.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,066.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,980.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,066.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,066.19
|
| Rate for Payer: Wellcare Medicare |
$28,562.88
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
IP
|
$47,444.85
|
|
|
Service Code
|
MS-DRG 255
|
| Min. Negotiated Rate |
$21,123.60 |
| Max. Negotiated Rate |
$47,444.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40,510.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45,427.10
|
| Rate for Payer: Aetna Government |
$45,427.10
|
| Rate for Payer: Brighton Health Commercial |
$39,837.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46,335.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47,444.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$39,153.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$43,155.74
|
| Rate for Payer: EmblemHealth Commercial |
$23,559.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$45,427.10
|
| Rate for Payer: Group Health Inc Commercial |
$45,427.10
|
| Rate for Payer: Group Health Inc Medicare |
$45,427.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45,427.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21,123.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45,427.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45,427.10
|
| Rate for Payer: Wellcare Medicare |
$43,155.74
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$21,491.82
|
|
|
Service Code
|
MS-DRG 257
|
| Min. Negotiated Rate |
$8,497.83 |
| Max. Negotiated Rate |
$21,491.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,612.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,070.41
|
| Rate for Payer: Aetna Government |
$21,070.41
|
| Rate for Payer: Brighton Health Commercial |
$14,369.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,491.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,113.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,122.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,016.89
|
| Rate for Payer: EmblemHealth Commercial |
$8,497.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,070.41
|
| Rate for Payer: Group Health Inc Commercial |
$21,070.41
|
| Rate for Payer: Group Health Inc Medicare |
$21,070.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,070.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,797.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,070.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,070.41
|
| Rate for Payer: Wellcare Medicare |
$20,016.89
|
|
|
UPPR GI ENDOSCOPY, DIAGNOSIS
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
UPPR GI ENDOSCOPY/GUIDE WIRE
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
41114201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$177.86 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$197.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
UPPR GI ENDOSCOPY,LIGATION
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
41114200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$261.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$261.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
UPPR GI ENDOSCOPY/ REMOV FOR BODY
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43247
|
| Hospital Charge Code |
41114210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$190.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
UPPR GI ENDOSCOPY, W BALLOON DILA
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43249
|
| Hospital Charge Code |
41114211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
UPPR GI ENDOSCOPY, W BIOPSY
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
41114209
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 93922 TC
|
| Hospital Charge Code |
41301524
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$78.29 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Government |
$165.12
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.29
|
| Rate for Payer: Group Health Inc Commercial |
$165.12
|
| Rate for Payer: Group Health Inc Medicare |
$115.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.99
|
|
|
UREA NITROGEN-BF.
|
Facility
OP
|
$9.88
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
40602678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.95
|
| Rate for Payer: Aetna Government |
$3.95
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.95
|
| Rate for Payer: EmblemHealth Commercial |
$3.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.52
|
| Rate for Payer: Group Health Inc Commercial |
$3.95
|
| Rate for Payer: Group Health Inc Medicare |
$3.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.95
|
| Rate for Payer: Healthfirst QHP |
$3.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.16
|
| Rate for Payer: Wellcare Medicare |
$3.56
|
|
|
UREA NITROGEN (UREA) (BUN)
|
Facility
OP
|
$9.88
|
|
|
Service Code
|
HCPCS 84520
|
| Hospital Charge Code |
40602080
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.95
|
| Rate for Payer: Aetna Government |
$3.95
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.95
|
| Rate for Payer: EmblemHealth Commercial |
$3.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.52
|
| Rate for Payer: Group Health Inc Commercial |
$3.95
|
| Rate for Payer: Group Health Inc Medicare |
$3.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.95
|
| Rate for Payer: Healthfirst QHP |
$3.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.16
|
| Rate for Payer: Wellcare Medicare |
$3.56
|
|
|
UREAPLASMA/MYCOPLASMA HOMINIS
|
Facility
OP
|
$38.48
|
|
|
Service Code
|
HCPCS 87109
|
| Hospital Charge Code |
40619187
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.39
|
| Rate for Payer: Aetna Government |
$15.39
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.39
|
| Rate for Payer: EmblemHealth Commercial |
$15.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.70
|
| Rate for Payer: Group Health Inc Commercial |
$15.39
|
| Rate for Payer: Group Health Inc Medicare |
$15.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.39
|
| Rate for Payer: Healthfirst QHP |
$15.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.31
|
| Rate for Payer: Wellcare Medicare |
$13.85
|
|
|
UREA-SKIN EMOLLIENT 20% CREAM
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
41653975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
|
UREA-SKIN EMOLLIENT 20% CREAM
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
41643975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
|
UR-EOSINOPHIL
|
Facility
OP
|
$11.80
|
|
|
Service Code
|
HCPCS 89050
|
| Hospital Charge Code |
40626005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.72
|
| Rate for Payer: Aetna Government |
$4.72
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.72
|
| Rate for Payer: EmblemHealth Commercial |
$4.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.20
|
| Rate for Payer: Group Health Inc Commercial |
$4.72
|
| Rate for Payer: Group Health Inc Medicare |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.72
|
| Rate for Payer: Healthfirst QHP |
$4.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.78
|
| Rate for Payer: Wellcare Medicare |
$4.25
|
|
|
URETERAL LITHOTOMY
|
Facility
OP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 50561
|
| Hospital Charge Code |
40123055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$419.42 |
| Max. Negotiated Rate |
$6,408.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,983.74
|
| Rate for Payer: Aetna Government |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,983.74
|
| 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 |
$5,983.74
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$419.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,086.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,325.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,983.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,325.53
|
| Rate for Payer: Group Health Inc Commercial |
$5,983.74
|
| Rate for Payer: Group Health Inc Medicare |
$5,983.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,983.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$466.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,086.18
|
| Rate for Payer: Healthfirst QHP |
$5,983.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,983.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,983.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,786.99
|
| Rate for Payer: Wellcare Medicare |
$5,684.55
|
|
|
URETERAL STENT
|
Facility
OP
|
$326.03
|
|
| Hospital Charge Code |
40207004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$260.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$179.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.02
|
| Rate for Payer: Aetna Government |
$163.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$260.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$221.70
|
| Rate for Payer: Group Health Inc Commercial |
$163.02
|
| Rate for Payer: Group Health Inc Medicare |
$114.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.02
|
|
|
URETEROLYSIS-RETROPER FIBROSIS
|
Facility
OP
|
$3,153.38
|
|
|
Service Code
|
HCPCS 50715
|
| Hospital Charge Code |
40129505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,103.68 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,734.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,525.26
|
| Rate for Payer: Aetna Government |
$1,525.26
|
| 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 |
$1,343.38
|
| Rate for Payer: Group Health Inc Commercial |
$1,576.69
|
| Rate for Payer: Group Health Inc Medicare |
$1,103.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,576.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,576.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,492.64
|
|
