|
SIGMOIDOSCOPY AND BIOPSY
|
Facility
|
IP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45331
|
| Hospital Charge Code |
41114206
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,056.92
|
|
|
SIGMOIDOSCOPY AND BIOPSY
|
Facility
|
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45331
|
| Hospital Charge Code |
41114206
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$845.54 |
| 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: Brighton Health Commercial |
$1,735.20
|
| 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 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 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 |
$845.54 |
| 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: Brighton Health Commercial |
$1,735.20
|
| 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 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 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
|
IP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45333
|
| Hospital Charge Code |
41114207
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,056.92
|
|
|
SIGMOIDOSCOPY/HEMORRHOIDECTOMY
|
Facility
|
IP
|
$7,099.93
|
|
|
Service Code
|
HCPCS 46250
|
| Hospital Charge Code |
40011220
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,246.99
|
|
|
SIGMOIDOSCOPY/HEMORRHOIDECTOMY
|
Facility
|
OP
|
$7,099.93
|
|
|
Service Code
|
HCPCS 46250
|
| Hospital Charge Code |
40011220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$5,324.95 |
| 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: Brighton Health Commercial |
$5,324.95
|
| 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 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 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
|
IP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 45334
|
| Hospital Charge Code |
41118917
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,364.66
|
|
|
SIGMOIDOSCOPY W CONTROL BLEEDING
|
Facility
|
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 45334
|
| Hospital Charge Code |
41118917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,091.73 |
| 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: Brighton Health Commercial |
$2,281.15
|
| 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 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 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 |
$845.54 |
| 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: Brighton Health Commercial |
$1,735.20
|
| 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 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 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 SUBMUCOSAL INJ
|
Facility
|
IP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45335
|
| Hospital Charge Code |
41114208
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,056.92
|
|
|
SIGMOIDOSCOPY W/TUMOR REMOVAL
|
Facility
|
IP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 45338
|
| Hospital Charge Code |
41118915
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,364.66
|
|
|
SIGMOIDOSCOPY W/TUMOR REMOVAL
|
Facility
|
OP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 45338
|
| Hospital Charge Code |
41118915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,091.73 |
| 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: Brighton Health Commercial |
$2,281.15
|
| 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 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 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
|
IP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45341
|
| Hospital Charge Code |
41112833
|
|
Hospital Revenue Code
|
750
|
| Rate for Payer: Cash Price |
$1,056.92
|
|
|
SIGMOIDOSCOPY W/ULTRASOUND
|
Facility
|
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45341
|
| Hospital Charge Code |
41112833
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$845.54 |
| 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: Brighton Health Commercial |
$1,735.20
|
| 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 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 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 |
$1,091.73 |
| 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: Brighton Health Commercial |
$2,281.15
|
| 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 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 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/US GUIDE
|
Facility
|
IP
|
$3,041.53
|
|
|
Service Code
|
HCPCS 45342
|
| Hospital Charge Code |
41118924
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,364.66
|
|
|
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 |
$3,154.29 |
| 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: Brighton Health Commercial |
$3,154.29
|
| 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: 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
|
|
|
SIGMOIDSCOPY
|
Facility
|
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
40000475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$845.54 |
| 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: Brighton Health Commercial |
$1,735.20
|
| 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 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 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
|
|
|
SIGMOIDSCOPY
|
Facility
|
IP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 45330
|
| Hospital Charge Code |
40000475
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,056.92
|
|
|
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: Brighton Health Commercial |
$3.19
|
| 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 |
$58.31 |
| 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: Brighton Health Commercial |
$124.95
|
| 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: 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
|
|
|
SIGNAL AVERAGE EKG
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 93278 TC
|
| Hospital Charge Code |
40801500
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
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
|
MSDRG 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
|
MSDRG 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
|
|
