|
ENDO BABCOCK
|
Facility
OP
|
$2,652.42
|
|
| Hospital Charge Code |
40201027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$928.35 |
| Max. Negotiated Rate |
$2,121.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,458.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,326.21
|
| Rate for Payer: Aetna Government |
$1,326.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,121.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,803.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,326.21
|
| Rate for Payer: Group Health Inc Medicare |
$928.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,326.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,326.21
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
30303082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.48 |
| 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: 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: 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 CHP/HARP/Medicaid |
$112.48
|
| 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 CHP/FHP/Medicaid |
$124.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.34
|
| Rate for Payer: Healthfirst QHP |
$370.99
|
| 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
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
OP
|
$1,933.73
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
30300092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$122.29 |
| 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 |
$929.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.29
|
| 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 |
$135.88
|
| 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
|
|
|
ENDOCHOICE COMPL ENDOKIT KS2820
|
Facility
OP
|
$14.00
|
|
| Hospital Charge Code |
66576679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
|
|
ENDO CHOLANGIO/BALLOON DILATION
|
Facility
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43277
|
| Hospital Charge Code |
40019917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$402.75 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$402.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$447.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ENDO CHOLANGIOPANCREATOGRAPHY
|
Facility
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
40014232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.12 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$343.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ENDO CHOLANGIOPANCREATOGRAPHY
|
Facility
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
41118920
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.12 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$343.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ENDO CHOLANGIO W SPHINECTEROTOMY
|
Facility
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
41114205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$380.39 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ENDOCHRINE SURGERY PROCEDURE
|
Facility
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 60699
|
| Hospital Charge Code |
40014090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,320.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| 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 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 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
|
|
|
ENDO CLIP II MD/LG 10MM PIS GRP
|
Facility
OP
|
$244.33
|
|
| Hospital Charge Code |
64904614
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.52 |
| Max. Negotiated Rate |
$195.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.16
|
| Rate for Payer: Aetna Government |
$122.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.14
|
| Rate for Payer: Group Health Inc Commercial |
$122.16
|
| Rate for Payer: Group Health Inc Medicare |
$85.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.16
|
|
|
ENDOCRINE DISORDERS WITH CC
|
Facility
IP
|
$22,491.86
|
|
|
Service Code
|
MS-DRG 644
|
| Min. Negotiated Rate |
$9,104.08 |
| Max. Negotiated Rate |
$22,491.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,654.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,050.84
|
| Rate for Payer: Aetna Government |
$22,050.84
|
| Rate for Payer: Brighton Health Commercial |
$15,394.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,491.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,334.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,130.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,948.30
|
| Rate for Payer: EmblemHealth Commercial |
$9,104.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,050.84
|
| Rate for Payer: Group Health Inc Commercial |
$22,050.84
|
| Rate for Payer: Group Health Inc Medicare |
$22,050.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,050.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,253.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,050.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,050.84
|
| Rate for Payer: Wellcare Medicare |
$20,948.30
|
|
|
ENDOCRINE DISORDERS WITH MCC
|
Facility
IP
|
$30,743.90
|
|
|
Service Code
|
MS-DRG 643
|
| Min. Negotiated Rate |
$14,015.60 |
| Max. Negotiated Rate |
$30,743.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24,257.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,141.08
|
| Rate for Payer: Aetna Government |
$30,141.08
|
| Rate for Payer: Brighton Health Commercial |
$23,853.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,743.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28,409.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,444.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$28,634.03
|
| Rate for Payer: EmblemHealth Commercial |
$14,106.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,141.08
|
| Rate for Payer: Group Health Inc Commercial |
$30,141.08
|
| Rate for Payer: Group Health Inc Medicare |
$30,141.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,141.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,015.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,141.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,141.08
|
| Rate for Payer: Wellcare Medicare |
$28,634.03
|
|
|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$18,237.13
|
|
|
Service Code
|
MS-DRG 645
|
| Min. Negotiated Rate |
$6,524.72 |
| Max. Negotiated Rate |
$18,237.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,219.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,879.54
|
| Rate for Payer: Aetna Government |
$17,879.54
|
| Rate for Payer: Brighton Health Commercial |
$11,033.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,237.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,139.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,843.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,985.56
|
| Rate for Payer: EmblemHealth Commercial |
$6,524.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,879.54
|
| Rate for Payer: Group Health Inc Commercial |
$17,879.54
|
| Rate for Payer: Group Health Inc Medicare |
$17,879.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,879.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,313.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,879.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,879.54
|
| Rate for Payer: Wellcare Medicare |
$16,985.56
|
|
|
ENDOCUTTER 35 MM BLUE
|
Facility
OP
|
$1,621.38
|
|
| Hospital Charge Code |
40200428
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$567.48 |
| Max. Negotiated Rate |
$1,297.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$891.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$810.69
|
| Rate for Payer: Aetna Government |
$810.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,297.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,102.54
|
| Rate for Payer: Group Health Inc Commercial |
$810.69
|
| Rate for Payer: Group Health Inc Medicare |
$567.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$810.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$810.69
|
|
|
ENDOCUTTER 45 MM BLUE
|
Facility
OP
|
$1,621.00
|
|
| Hospital Charge Code |
40200429
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$567.35 |
| Max. Negotiated Rate |
$1,296.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$891.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$810.50
|
| Rate for Payer: Aetna Government |
$810.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,296.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,102.28
|
| Rate for Payer: Group Health Inc Commercial |
$810.50
|
| Rate for Payer: Group Health Inc Medicare |
$567.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$810.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$810.50
|
|
|
ENDOCUTTER RELOAD 35MM BLUE
|
Facility
OP
|
$2,385.26
|
|
| Hospital Charge Code |
40200435
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$834.84 |
| Max. Negotiated Rate |
$1,908.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,311.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,192.63
|
| Rate for Payer: Aetna Government |
$1,192.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,908.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,621.98
|
| Rate for Payer: Group Health Inc Commercial |
$1,192.63
|
| Rate for Payer: Group Health Inc Medicare |
$834.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,192.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,192.63
|
|
|
ENDOCUTTER RELOAD 35MM WHITE
|
Facility
OP
|
$2,385.26
|
|
| Hospital Charge Code |
40200436
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$834.84 |
| Max. Negotiated Rate |
$1,908.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,311.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,192.63
|
| Rate for Payer: Aetna Government |
$1,192.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,908.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,621.98
|
| Rate for Payer: Group Health Inc Commercial |
$1,192.63
|
| Rate for Payer: Group Health Inc Medicare |
$834.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,192.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,192.63
|
|
|
ENDOCUTTER RELOAD 45MM BLUE
|
Facility
OP
|
$2,230.30
|
|
| Hospital Charge Code |
40200437
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$780.60 |
| Max. Negotiated Rate |
$1,784.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,226.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,115.15
|
| Rate for Payer: Aetna Government |
$1,115.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,784.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,516.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,115.15
|
| Rate for Payer: Group Health Inc Medicare |
$780.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,115.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,115.15
|
|
|
ENDOCUTTER RELOAD 45MM GREEN
|
Facility
OP
|
$2,230.30
|
|
| Hospital Charge Code |
40200438
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$780.60 |
| Max. Negotiated Rate |
$1,784.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,226.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,115.15
|
| Rate for Payer: Aetna Government |
$1,115.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,784.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,516.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,115.15
|
| Rate for Payer: Group Health Inc Medicare |
$780.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,115.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,115.15
|
|
|
ENDOCUTTER RELOAD 45MM WHITE
|
Facility
OP
|
$2,590.00
|
|
| Hospital Charge Code |
40200439
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$906.50 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,424.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,295.00
|
| Rate for Payer: Aetna Government |
$1,295.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,072.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,761.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,295.00
|
| Rate for Payer: Group Health Inc Medicare |
$906.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,295.00
|
|
|
ENDOCUTTER VASCULAR 35MM
|
Facility
OP
|
$1,780.00
|
|
| Hospital Charge Code |
40200440
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$623.00 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$979.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$890.00
|
| Rate for Payer: Aetna Government |
$890.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,424.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,210.40
|
| Rate for Payer: Group Health Inc Commercial |
$890.00
|
| Rate for Payer: Group Health Inc Medicare |
$623.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$890.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$890.00
|
|
|
ENDOCUTTER VASCULAR 45 MM
|
Facility
OP
|
$1,236.00
|
|
| Hospital Charge Code |
40200430
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$432.60 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$679.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$618.00
|
| Rate for Payer: Aetna Government |
$618.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$988.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$840.48
|
| Rate for Payer: Group Health Inc Commercial |
$618.00
|
| Rate for Payer: Group Health Inc Medicare |
$432.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$618.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$618.00
|
|
|
ENDODONTIC ENDOSSEOUS IMPLANT
|
Facility
OP
|
$1,984.50
|
|
|
Service Code
|
HCPCS D3460
|
| Hospital Charge Code |
42300800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$814.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,091.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| 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 |
$992.25
|
| 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: Senior Whole Health 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
|
|
|
END OF LIFE COUNSELING
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
HCPCS S0257
|
| Hospital Charge Code |
30305816
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.09
|
| Rate for Payer: Aetna Government |
$2.09
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
ENDOFORM
|
Facility
OP
|
$87.80
|
|
| Hospital Charge Code |
64905626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.73 |
| Max. Negotiated Rate |
$70.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.90
|
| Rate for Payer: Aetna Government |
$43.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.70
|
| Rate for Payer: Group Health Inc Commercial |
$43.90
|
| Rate for Payer: Group Health Inc Medicare |
$30.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.90
|
|
