|
VACURETTE SIZE 10
|
Facility
|
OP
|
$16.20
|
|
| Hospital Charge Code |
64902913
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.10
|
| Rate for Payer: Aetna Government |
$8.10
|
| Rate for Payer: Brighton Health Commercial |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.02
|
| Rate for Payer: Group Health Inc Commercial |
$8.10
|
| Rate for Payer: Group Health Inc Medicare |
$5.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.10
|
|
|
VACURETTE SIZE 12
|
Facility
|
OP
|
$13.50
|
|
| Hospital Charge Code |
64902915
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.75
|
| Rate for Payer: Aetna Government |
$6.75
|
| Rate for Payer: Brighton Health Commercial |
$10.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.18
|
| Rate for Payer: Group Health Inc Commercial |
$6.75
|
| Rate for Payer: Group Health Inc Medicare |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.75
|
|
|
VACURETTE SIZE 7
|
Facility
|
OP
|
$11.75
|
|
| Hospital Charge Code |
64902906
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.88
|
| Rate for Payer: Aetna Government |
$5.88
|
| Rate for Payer: Brighton Health Commercial |
$8.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.99
|
| Rate for Payer: Group Health Inc Commercial |
$5.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.88
|
|
|
VACURETTE SIZE 8
|
Facility
|
OP
|
$11.45
|
|
| Hospital Charge Code |
64902909
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$9.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.72
|
| Rate for Payer: Aetna Government |
$5.72
|
| Rate for Payer: Brighton Health Commercial |
$8.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.79
|
| Rate for Payer: Group Health Inc Commercial |
$5.72
|
| Rate for Payer: Group Health Inc Medicare |
$4.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.72
|
|
|
VACURETTE SIZE 9
|
Facility
|
OP
|
$16.20
|
|
| Hospital Charge Code |
64902911
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.10
|
| Rate for Payer: Aetna Government |
$8.10
|
| Rate for Payer: Brighton Health Commercial |
$12.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.02
|
| Rate for Payer: Group Health Inc Commercial |
$8.10
|
| Rate for Payer: Group Health Inc Medicare |
$5.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.10
|
|
|
VAC WHITE FOAM LG
|
Facility
|
OP
|
$32.18
|
|
| Hospital Charge Code |
40201956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$25.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.09
|
| Rate for Payer: Aetna Government |
$16.09
|
| Rate for Payer: Brighton Health Commercial |
$24.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.88
|
| Rate for Payer: Group Health Inc Commercial |
$16.09
|
| Rate for Payer: Group Health Inc Medicare |
$11.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.09
|
|
|
VAC WHITE FOAM SM
|
Facility
|
OP
|
$25.19
|
|
| Hospital Charge Code |
40201955
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.60
|
| Rate for Payer: Aetna Government |
$12.60
|
| Rate for Payer: Brighton Health Commercial |
$18.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.13
|
| Rate for Payer: Group Health Inc Commercial |
$12.60
|
| Rate for Payer: Group Health Inc Medicare |
$8.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.60
|
|
|
VAG DEL AFTR CESARIN INCL ANTE/PO
|
Facility
|
OP
|
$8,701.05
|
|
|
Service Code
|
HCPCS 59610
|
| Hospital Charge Code |
40002231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,525.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,785.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,523.00
|
| Rate for Payer: Aetna Government |
$2,523.00
|
| Rate for Payer: Brighton Health Commercial |
$6,525.79
|
| 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 |
$4,350.52
|
| Rate for Payer: Group Health Inc Medicare |
$3,045.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,350.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,350.52
|
|
|
VAG DELIVERY AFTER CESARIAN
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
30102504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
VAG DELIVERY AFTER CESARIAN
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
40052241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
VAG DELIVERY AFTER CESARIAN
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
30102504
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
VAG DELIVERY AFTER CESARIAN
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59612
|
| Hospital Charge Code |
40052241
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$31,182.39
|
|
|
Service Code
|
MSDRG 746
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$31,182.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,714.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,570.97
|
| Rate for Payer: Aetna Government |
$30,570.97
|
| Rate for Payer: Brighton Health Commercial |
$24,303.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,182.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,944.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,886.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,042.42
|
| Rate for Payer: EmblemHealth Commercial |
$14,372.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,570.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$30,570.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,570.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,215.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,570.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,570.97
|
| Rate for Payer: Wellcare Medicare |
$29,042.42
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$20,023.60
|
|
|
Service Code
|
MSDRG 747
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$20,023.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,081.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,630.98
|
| Rate for Payer: Aetna Government |
$19,630.98
|
| Rate for Payer: Brighton Health Commercial |
$12,864.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,023.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,321.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,643.59
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,649.43
|
| Rate for Payer: EmblemHealth Commercial |
$7,607.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,630.98
|
| Rate for Payer: Group Health Inc Commercial |
$1,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$19,630.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,630.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,128.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,630.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,630.98
|
| Rate for Payer: Wellcare Medicare |
$18,649.43
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
30102501
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
30102501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
30102460
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
40019719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
30102460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
30302460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
30302460
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
VAGINAL DELIVERY ONLY
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59409
|
| Hospital Charge Code |
40019719
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$24,704.09
|
|
|
Service Code
|
MSDRG 768
|
| Min. Negotiated Rate |
$5,045.00 |
| Max. Negotiated Rate |
$24,704.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,960.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,219.70
|
| Rate for Payer: Aetna Government |
$24,219.70
|
| Rate for Payer: Brighton Health Commercial |
$17,662.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,704.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,035.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,359.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,008.72
|
| Rate for Payer: EmblemHealth Commercial |
$5,045.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,219.70
|
| Rate for Payer: Group Health Inc Commercial |
$7,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$24,219.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,219.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,262.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,219.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,219.70
|
| Rate for Payer: Wellcare Medicare |
$23,008.72
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
|
IP
|
$18,036.28
|
|
|
Service Code
|
MSDRG 806
|
| Min. Negotiated Rate |
$6,402.95 |
| Max. Negotiated Rate |
$18,036.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,010.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,682.63
|
| Rate for Payer: Aetna Government |
$17,682.63
|
| Rate for Payer: Brighton Health Commercial |
$10,827.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,036.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,894.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,641.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,798.50
|
| Rate for Payer: EmblemHealth Commercial |
$6,402.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,682.63
|
| Rate for Payer: Group Health Inc Commercial |
$17,682.63
|
| Rate for Payer: Group Health Inc Medicare |
$17,682.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,682.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,222.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,682.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,682.63
|
| Rate for Payer: Wellcare Medicare |
$16,798.50
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$21,735.12
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$8,645.32 |
| Max. Negotiated Rate |
$21,735.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14,865.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,308.94
|
| Rate for Payer: Aetna Government |
$21,308.94
|
| Rate for Payer: Brighton Health Commercial |
$14,618.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,735.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,410.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,367.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,243.49
|
| Rate for Payer: EmblemHealth Commercial |
$8,645.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,308.94
|
| Rate for Payer: Group Health Inc Commercial |
$21,308.94
|
| Rate for Payer: Group Health Inc Medicare |
$21,308.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,308.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,908.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,308.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,308.94
|
| Rate for Payer: Wellcare Medicare |
$20,243.49
|
|
