|
COLPOSCOPY OF VAGINA
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
30303063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$370.99
|
| Rate for Payer: Aetna Government |
$370.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$259.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$259.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$259.69
|
| 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: 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 Essential Plan Aliesa |
$315.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.18
|
| 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 |
$407.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.34
|
| Rate for Payer: Healthfirst QHP |
$370.99
|
| Rate for Payer: Humana Medicare |
$378.41
|
| 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: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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
|
|
|
COLPOSCOPY OF VAGINA W BIOPSY
|
Facility
|
IP
|
$1,933.73
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
30303072
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$929.66
|
|
|
COLPOSCOPY OF VAGINA W BIOPSY
|
Facility
|
OP
|
$1,933.73
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
30303072
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| 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: Affinity Essential Plan 1&2 |
$650.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$650.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$650.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$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: 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$790.21
|
| Rate for Payer: Healthfirst QHP |
$929.66
|
| Rate for Payer: Humana Medicare |
$948.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$929.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.66
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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
|
|
|
COLPO VESICAL SUSPENSION
|
Facility
|
IP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 57284
|
| Hospital Charge Code |
40122910
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,751.94
|
|
|
COLPO VESICAL SUSPENSION
|
Facility
|
OP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 57284
|
| Hospital Charge Code |
40122910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$9,703.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,751.94
|
| Rate for Payer: Aetna Government |
$5,751.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,026.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,026.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,026.36
|
| Rate for Payer: Brighton Health Commercial |
$9,703.07
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,751.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$5,751.94
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,889.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,119.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,751.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,119.23
|
| Rate for Payer: Group Health Inc Commercial |
$5,751.94
|
| Rate for Payer: Group Health Inc Medicare |
$5,751.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,468.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,751.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,889.15
|
| Rate for Payer: Healthfirst QHP |
$5,751.94
|
| Rate for Payer: Humana Medicare |
$5,866.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,751.94
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,751.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,751.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,601.55
|
| Rate for Payer: Wellcare Medicare |
$5,464.34
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC
|
Facility
|
IP
|
$126,699.28
|
|
|
Service Code
|
MSDRG 454
|
| Min. Negotiated Rate |
$42,847.39 |
| Max. Negotiated Rate |
$126,699.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90,184.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$92,144.93
|
| Rate for Payer: Aetna Government |
$92,144.93
|
| Rate for Payer: Brighton Health Commercial |
$88,686.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93,987.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105,622.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87,164.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$87,537.68
|
| Rate for Payer: EmblemHealth Commercial |
$52,447.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$92,144.93
|
| Rate for Payer: Group Health Inc Commercial |
$92,144.93
|
| Rate for Payer: Group Health Inc Medicare |
$92,144.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92,144.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42,847.39
|
| Rate for Payer: Humana Medicare |
$126,699.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92,144.93
|
| Rate for Payer: United Healthcare Commercial |
$121,634.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92,144.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92,144.93
|
| Rate for Payer: Wellcare Medicare |
$87,537.68
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$179,041.91
|
|
|
Service Code
|
MSDRG 453
|
| Min. Negotiated Rate |
$60,548.72 |
| Max. Negotiated Rate |
$179,041.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130,661.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130,212.30
|
| Rate for Payer: Aetna Government |
$130,212.30
|
| Rate for Payer: Brighton Health Commercial |
$128,490.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132,816.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$153,027.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126,284.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$123,701.68
|
| Rate for Payer: EmblemHealth Commercial |
$75,986.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$130,212.30
|
| Rate for Payer: Group Health Inc Commercial |
$130,212.30
|
| Rate for Payer: Group Health Inc Medicare |
$130,212.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130,212.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60,548.72
|
| Rate for Payer: Humana Medicare |
$179,041.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130,212.30
|
| Rate for Payer: United Healthcare Commercial |
$176,226.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130,212.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130,212.30
|
| Rate for Payer: Wellcare Medicare |
$123,701.68
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$97,893.76
|
|
|
Service Code
|
MSDRG 455
|
| Min. Negotiated Rate |
$33,105.89 |
| Max. Negotiated Rate |
$97,893.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67,909.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$71,195.46
|
| Rate for Payer: Aetna Government |
$71,195.46
|
| Rate for Payer: Brighton Health Commercial |
$66,781.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72,619.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79,534.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65,634.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$67,635.69
|
| Rate for Payer: EmblemHealth Commercial |
$39,493.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$71,195.46
|
| Rate for Payer: Group Health Inc Commercial |
$71,195.46
|
| Rate for Payer: Group Health Inc Medicare |
$71,195.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71,195.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33,105.89
|
| Rate for Payer: Humana Medicare |
$97,893.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71,195.46
|
| Rate for Payer: United Healthcare Commercial |
$91,591.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71,195.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71,195.46
|
| Rate for Payer: Wellcare Medicare |
$67,635.69
|
|
|
COMBINEDCONN.TISSUE&DOUBLEGRAFT
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
HCPCS D4276
|
| Hospital Charge Code |
42303394
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$584.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,234.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,234.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,234.52
|
| Rate for Payer: Brighton Health Commercial |
$797.25
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| 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 |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,763.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Humana Medicare |
$1,798.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
COMBINEDCONN.TISSUE&DOUBLEGRAFT
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
HCPCS D4276
|
| Hospital Charge Code |
42303394
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,763.60
|
|
|
COMBO FIXATION BOLT
|
Facility
|
IP
|
$239.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$119.50 |
| Max. Negotiated Rate |
$119.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.50
|
|
|
COMBO FIXATION BOLT
|
Facility
|
OP
|
$239.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.65 |
| Max. Negotiated Rate |
$250.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$131.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$143.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$137.42
|
| Rate for Payer: EmblemHealth Commercial |
$119.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.95
|
| Rate for Payer: Group Health Inc Commercial |
$119.50
|
| Rate for Payer: Group Health Inc Medicare |
$83.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.35
|
|
|
COMBO SPINAL EPI CONT TRAY 18GA
|
Facility
|
OP
|
$79.94
|
|
| Hospital Charge Code |
64903804
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$63.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.97
|
| Rate for Payer: Aetna Government |
$39.97
|
| Rate for Payer: Brighton Health Commercial |
$59.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.36
|
| Rate for Payer: Group Health Inc Commercial |
$39.97
|
| Rate for Payer: Group Health Inc Medicare |
$27.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.97
|
|
|
CO/MEMBANE DIFFUSING CAPACITY
|
Facility
|
OP
|
$173.43
|
|
|
Service Code
|
HCPCS 94729 TC
|
| Hospital Charge Code |
30305591
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.84
|
| Rate for Payer: Aetna Government |
$40.84
|
| Rate for Payer: Brighton Health Commercial |
$130.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$138.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$117.93
|
| Rate for Payer: Group Health Inc Commercial |
$86.72
|
| Rate for Payer: Group Health Inc Medicare |
$60.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.72
|
| Rate for Payer: United Healthcare Commercial |
$86.72
|
|
|
COMMISSURE SPLINT
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
HCPCS D5987
|
| Hospital Charge Code |
42301400
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
COMMISSURE SPLINT
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
HCPCS D5987
|
| Hospital Charge Code |
42301400
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$312.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$426.00
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
COMMON DUCT EXPLORATION
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
40010670
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,903.87
|
|
|
COMMON DUCT EXPLORATION
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47564
|
| Hospital Charge Code |
40010670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$12,141.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11,903.87
|
| Rate for Payer: Aetna Government |
$11,903.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,332.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,332.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,332.71
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11,903.87
|
| 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 |
$11,903.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,118.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,594.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,903.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,594.44
|
| Rate for Payer: Group Health Inc Commercial |
$11,903.87
|
| Rate for Payer: Group Health Inc Medicare |
$11,903.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,903.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,118.29
|
| Rate for Payer: Healthfirst QHP |
$11,903.87
|
| Rate for Payer: Humana Medicare |
$12,141.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11,903.87
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,903.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11,903.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,523.10
|
| Rate for Payer: Wellcare Medicare |
$11,308.68
|
|
|
CO-MORBID CONDITION ASSESS
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS 1026F
|
| Hospital Charge Code |
30305699
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| 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: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
|
|
COMP ACET BIPOLAR 43X28MM
|
Facility
|
IP
|
$2,522.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64901618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.25 |
| Max. Negotiated Rate |
$1,261.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,261.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,261.25
|
|
|
COMP ACET BIPOLAR 43X28MM
|
Facility
|
OP
|
$2,522.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64901618
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,648.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,387.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$1,513.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,261.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,450.44
|
| Rate for Payer: EmblemHealth Commercial |
$1,261.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,648.62
|
| Rate for Payer: Group Health Inc Commercial |
$1,261.25
|
| Rate for Payer: Group Health Inc Medicare |
$882.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,261.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,261.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,639.62
|
|
|
COMP FEM CRU RET RT 68MM
|
Facility
|
OP
|
$10,467.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$10,991.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,757.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$6,280.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,233.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,018.96
|
| Rate for Payer: EmblemHealth Commercial |
$5,233.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,991.14
|
| Rate for Payer: Group Health Inc Commercial |
$5,233.88
|
| Rate for Payer: Group Health Inc Medicare |
$3,663.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,233.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,233.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,804.04
|
|
|
COMP FEM CRU RET RT 68MM
|
Facility
|
IP
|
$10,467.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64901471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,233.88 |
| Max. Negotiated Rate |
$5,233.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,233.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,233.88
|
|
|
COMP FEMORAL POST STAB SZ4 RGHT
|
Facility
|
IP
|
$6,744.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,372.12 |
| Max. Negotiated Rate |
$3,372.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,372.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,372.12
|
|
|
COMP FEMORAL POST STAB SZ4 RGHT
|
Facility
|
OP
|
$6,744.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$7,081.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,709.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$4,046.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,372.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,877.94
|
| Rate for Payer: EmblemHealth Commercial |
$3,372.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,081.46
|
| Rate for Payer: Group Health Inc Commercial |
$3,372.12
|
| Rate for Payer: Group Health Inc Medicare |
$2,360.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,372.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,372.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,383.76
|
|
