|
DB 360 1.25MICRO CROWNX145CM OAS
|
Facility
OP
|
$6,790.00
|
|
| Hospital Charge Code |
40006509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,376.50 |
| Max. Negotiated Rate |
$5,432.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,734.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,395.00
|
| Rate for Payer: Aetna Government |
$3,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,617.20
|
| Rate for Payer: Group Health Inc Commercial |
$3,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,376.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,395.00
|
|
|
DB 360 1.25SOLID CROWN X145CM OAS
|
Facility
OP
|
$6,790.00
|
|
| Hospital Charge Code |
40006510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,376.50 |
| Max. Negotiated Rate |
$5,432.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,734.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,395.00
|
| Rate for Payer: Aetna Government |
$3,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,617.20
|
| Rate for Payer: Group Health Inc Commercial |
$3,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,376.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,395.00
|
|
|
DB 360 1.50 CROWNX145CM OAS
|
Facility
OP
|
$6,790.00
|
|
| Hospital Charge Code |
40006508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,376.50 |
| Max. Negotiated Rate |
$5,432.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,734.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,395.00
|
| Rate for Payer: Aetna Government |
$3,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,617.20
|
| Rate for Payer: Group Health Inc Commercial |
$3,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,376.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,395.00
|
|
|
DB 360 1.50 SOLID CROWNX145CM OAS
|
Facility
OP
|
$6,790.00
|
|
| Hospital Charge Code |
40006511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,376.50 |
| Max. Negotiated Rate |
$5,432.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,734.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,395.00
|
| Rate for Payer: Aetna Government |
$3,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,617.20
|
| Rate for Payer: Group Health Inc Commercial |
$3,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,376.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,395.00
|
|
|
DB 360 2.00 SOLID CROWNX145CM OAS
|
Facility
OP
|
$6,790.00
|
|
| Hospital Charge Code |
40006512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,376.50 |
| Max. Negotiated Rate |
$5,432.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,734.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,395.00
|
| Rate for Payer: Aetna Government |
$3,395.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,432.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,617.20
|
| Rate for Payer: Group Health Inc Commercial |
$3,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,376.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,395.00
|
|
|
D & C
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
40052185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$261.74 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$261.74
|
| 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 CHP/FHP/Medicaid |
$290.82
|
| 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
|
|
|
D&C BIOPSY OF THE CERVIX
|
Facility
OP
|
$1,933.73
|
|
|
Service Code
|
HCPCS 57500
|
| Hospital Charge Code |
40053209
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$929.66
|
| Rate for Payer: Aetna Government |
$929.66
|
| Rate for Payer: Cash Price |
$929.66
|
| Rate for Payer: Cash Price |
$929.66
|
| Rate for Payer: Cash Price |
$929.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$929.66
|
| 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 |
$929.66
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$790.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$827.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$929.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$827.40
|
| Rate for Payer: Group Health Inc Commercial |
$929.66
|
| Rate for Payer: Group Health Inc Medicare |
$929.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$790.21
|
| Rate for Payer: Healthfirst QHP |
$929.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$929.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$743.73
|
| Rate for Payer: Wellcare Medicare |
$883.18
|
|
|
DCB-PT DRILL GUIDE 3.3/1.6MM
|
Facility
OP
|
$415.30
|
|
| Hospital Charge Code |
40006751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.36 |
| Max. Negotiated Rate |
$332.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$228.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$207.65
|
| Rate for Payer: Aetna Government |
$207.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$332.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$282.40
|
| Rate for Payer: Group Health Inc Commercial |
$207.65
|
| Rate for Payer: Group Health Inc Medicare |
$145.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.65
|
|
|
D&C CONIZATION
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57520
|
| Hospital Charge Code |
40053210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.54 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$332.54
|
| 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 CHP/FHP/Medicaid |
$369.49
|
| 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
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
IP
|
$34,100.42
|
|
|
Service Code
|
MS-DRG 744
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$34,100.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27,755.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,431.78
|
| Rate for Payer: Aetna Government |
$33,431.78
|
| Rate for Payer: Brighton Health Commercial |
$27,294.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34,100.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32,507.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,826.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,760.19
|
| Rate for Payer: EmblemHealth Commercial |
$16,141.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,431.78
|
| Rate for Payer: Group Health Inc Commercial |
$1,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$33,431.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,431.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,545.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,431.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,431.78
|
| Rate for Payer: Wellcare Medicare |
$31,760.19
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
IP
|
$22,126.92
|
|
|
Service Code
|
MS-DRG 745
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$22,126.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,274.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,693.06
|
| Rate for Payer: Aetna Government |
$21,693.06
|
| Rate for Payer: Brighton Health Commercial |
$15,020.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,126.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,888.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,762.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,608.41
|
| Rate for Payer: EmblemHealth Commercial |
$8,882.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,693.06
|
| Rate for Payer: Group Health Inc Commercial |
$1,000.00
|
| Rate for Payer: Group Health Inc Medicare |
$21,693.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,693.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,087.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,693.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,693.06
|
| Rate for Payer: Wellcare Medicare |
$20,608.41
|
|
|
D&C EXPLOR LAP, REMOVAL IUD
|
Facility
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
30301506
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$370.99
|
| Rate for Payer: Aetna Government |
$370.99
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.99
|
| 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 |
$370.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.99
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$296.79
|
| Rate for Payer: Wellcare Medicare |
$352.44
|
|
|
D&C EXPLOR LAP-, REMOVAL IUD
|
Facility
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
30103236
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$370.99
|
| Rate for Payer: Aetna Government |
$370.99
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$370.99
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.99
|
| 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 |
$370.99
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.99
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$296.79
|
| Rate for Payer: Wellcare Medicare |
$352.44
|
|
|
D&C-EXPLOR LAP-,REMOVAL IUD
|
Facility
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
40052195
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$296.79 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$370.99
|
| Rate for Payer: Aetna Government |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.99
|
| 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 |
$370.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.99
|
| Rate for Payer: Group Health Inc Commercial |
$370.99
|
| Rate for Payer: Group Health Inc Medicare |
$370.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$296.79
|
| Rate for Payer: Wellcare Medicare |
$352.44
|
|
|
D&C-EXPLR LAP-SALPINGO-OOPH
|
Facility
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
40052200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$732.47 |
| Max. Negotiated Rate |
$7,320.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$732.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$813.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
D&C INCOMPLETE ABORTION
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
40059636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.95 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$364.95
|
| 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 CHP/FHP/Medicaid |
$405.50
|
| 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
|
|
|
D&C LEEP CONE BIOPSY
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57460
|
| Hospital Charge Code |
40053258
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$177.48 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.48
|
| 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 CHP/FHP/Medicaid |
$197.20
|
| 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
|
|
|
D&C LEEP CONE BIOPSY
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 57460
|
| Hospital Charge Code |
30302440
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$177.48 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$177.48
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$197.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| 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
|
|
|
DCM CR TIBIAL BEARING 12MMX63/67M
|
Facility
OP
|
$2,208.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,214.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,269.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,318.40
|
| Rate for Payer: Group Health Inc Commercial |
$1,104.00
|
| Rate for Payer: Group Health Inc Medicare |
$772.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,104.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,435.20
|
|
|
DCM CR TIBIAL BEARING 12MMX63/67M
|
Facility
IP
|
$2,208.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,104.00
|
|
|
DCM CR TIBIAL BEARING 18MMX71/75M
|
Facility
OP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,872.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,552.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,320.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,668.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,872.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,320.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,016.00
|
|
|
DCM CR TIBIAL BEARING 18MMX71/75M
|
Facility
IP
|
$4,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,320.00 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,320.00
|
|
|
D&C MISSED ABORT 2ND TRIMESTER
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59821
|
| Hospital Charge Code |
40059638
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$448.64 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$448.64
|
| 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 CHP/FHP/Medicaid |
$498.49
|
| 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
|
|
|
D&C MISSED ABORT 2ND TRIMESTER
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59821
|
| Hospital Charge Code |
30102505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| 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 CHP/HARP/Medicaid |
$448.64
|
| 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
|
|
|
D&C MISSED ABORT FIRST TRIMESTER
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
40059637
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.44 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$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 |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.44
|
| 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 CHP/FHP/Medicaid |
$507.15
|
| 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
|
|
