|
U PD-RESIN BASE INCL. CONVEN. CLA
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS D5211
|
| Hospital Charge Code |
42300980
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$37,121.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$481.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.83
|
| Rate for Payer: Aetna Government |
$339.83
|
| Rate for Payer: Amida Care Medicaid |
$371.21
|
| Rate for Payer: Brighton Health Commercial |
$656.25
|
| 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: Fidelis CHP/HARP/Medicaid |
$37,121.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$371.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$389.77
|
| Rate for Payer: Group Health Inc Commercial |
$437.50
|
| Rate for Payer: Group Health Inc Medicare |
$306.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$371.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$437.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$371.21
|
| Rate for Payer: Healthfirst Essential Plan |
$835.22
|
| Rate for Payer: Healthfirst QHP |
$371.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$371.21
|
| Rate for Payer: SOMOS Essential |
$835.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$371.21
|
|
|
UPPERFACE/MIDFACE 3 PRONG BENDER
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$516.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$270.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$295.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$246.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$282.90
|
| Rate for Payer: EmblemHealth Commercial |
$246.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$516.60
|
| Rate for Payer: Group Health Inc Commercial |
$246.00
|
| Rate for Payer: Group Health Inc Medicare |
$172.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.80
|
|
|
UPPERFACE/MIDFACE 3 PRONG BENDER
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209872
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.00
|
|
|
UPPERFACE/MIDFACE IN-SITU PLATE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209873
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.00 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$575.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$575.00
|
|
|
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: Brighton Health Commercial |
$690.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$575.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$661.25
|
| Rate for Payer: EmblemHealth Commercial |
$575.00
|
| 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 |
$955.00 |
| 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 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 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
|
Facility
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43250
|
| Hospital Charge Code |
40019862
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
|
UPPER GI ENDOSCOPY/TUMOR BY SNARE
|
Facility
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43251
|
| Hospital Charge Code |
40014231
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
|
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 |
$955.00 |
| 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 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 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 |
$955.00 |
| 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 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 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
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43255
|
| Hospital Charge Code |
40019665
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
|
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 |
$955.00 |
| 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 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 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
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43245
|
| Hospital Charge Code |
41114204
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
|
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 |
$838.62 |
| 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 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 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 GI SCOPE W SUBMUCOSAL INJ
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43236
|
| Hospital Charge Code |
41114203
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
|
IP
|
$30,667.51
|
|
|
Service Code
|
MSDRG 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
|
MSDRG 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
|
MSDRG 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 |
$838.62 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| 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 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 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, DIAGNOSIS
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118220
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
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 |
$838.62 |
| 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 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 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
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43248
|
| Hospital Charge Code |
41114201
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
UPPR GI ENDOSCOPY,LIGATION
|
Facility
|
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
41114200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| 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 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 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,LIGATION
|
Facility
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43244
|
| Hospital Charge Code |
41114200
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
|
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 |
$838.62 |
| 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 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 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
|
|
