|
ENDOPROSTHESIS AAA EXCLUDER(CEB23
|
Facility
OP
|
$11,576.00
|
|
| Hospital Charge Code |
64906371
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$4,051.60 |
| Max. Negotiated Rate |
$9,260.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,366.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,788.00
|
| Rate for Payer: Aetna Government |
$5,788.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9,260.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,871.68
|
| Rate for Payer: Group Health Inc Commercial |
$5,788.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,051.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,788.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,788.00
|
|
|
ENDOPROSTHESIS CNTLT AAA18M PLC00
|
Facility
OP
|
$4,857.00
|
|
| Hospital Charge Code |
64906462
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,699.95 |
| Max. Negotiated Rate |
$3,885.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,671.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,428.50
|
| Rate for Payer: Aetna Government |
$2,428.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,885.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,302.76
|
| Rate for Payer: Group Health Inc Commercial |
$2,428.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,699.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,428.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,428.50
|
|
|
ENDOPROSTHSIS AAA EXCLUDR(RLT2812
|
Facility
OP
|
$11,846.00
|
|
| Hospital Charge Code |
64906374
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$4,146.10 |
| Max. Negotiated Rate |
$9,476.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,515.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,923.00
|
| Rate for Payer: Aetna Government |
$5,923.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9,476.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,055.28
|
| Rate for Payer: Group Health Inc Commercial |
$5,923.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,146.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,923.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,923.00
|
|
|
ENDOPROSTSIS AAA EXCLUDR (PLC2712
|
Facility
OP
|
$4,857.00
|
|
| Hospital Charge Code |
64906372
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,699.95 |
| Max. Negotiated Rate |
$3,885.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,671.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,428.50
|
| Rate for Payer: Aetna Government |
$2,428.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,885.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,302.76
|
| Rate for Payer: Group Health Inc Commercial |
$2,428.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,699.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,428.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,428.50
|
|
|
ENDOPROSTSIS AAA EXLUDR(HGB161007
|
Facility
OP
|
$3,231.00
|
|
| Hospital Charge Code |
64906373
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,130.85 |
| Max. Negotiated Rate |
$2,584.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,777.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,615.50
|
| Rate for Payer: Aetna Government |
$1,615.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,584.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,197.08
|
| Rate for Payer: Group Health Inc Commercial |
$1,615.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,130.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,615.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,615.50
|
|
|
ENDOPROTHS ILC EXT AAA 14.5MM
|
Facility
OP
|
$3,418.00
|
|
| Hospital Charge Code |
64906463
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,196.30 |
| Max. Negotiated Rate |
$2,734.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,879.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,709.00
|
| Rate for Payer: Aetna Government |
$1,709.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,734.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,324.24
|
| Rate for Payer: Group Health Inc Commercial |
$1,709.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,196.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,709.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,709.00
|
|
|
ENDO ROTHNET BASKET
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
40203657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 74328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.34 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.34
|
| Rate for Payer: Aetna Government |
$94.34
|
| 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
|
|
|
ENDOSCOPIC INJECTION/IMPLANT
|
Facility
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 51715
|
| Hospital Charge Code |
40123276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$216.64 |
| Max. Negotiated Rate |
$4,571.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Cash Price |
$4,031.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| 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 |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
Endoscopic plantar fasciotomy
|
Facility
OP
|
$5,593.00
|
|
|
Service Code
|
CPT 29893
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$467.79 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$467.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$519.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent
|
Facility
OP
|
$6,590.73
|
|
|
Service Code
|
CPT 43274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.51 |
| Max. Negotiated Rate |
$6,590.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,590.73
|
| Rate for Payer: Aetna Government |
$6,590.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,590.73
|
| 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 |
$6,590.73
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$492.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,602.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,865.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,590.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,865.75
|
| Rate for Payer: Group Health Inc Commercial |
$6,590.73
|
| Rate for Payer: Group Health Inc Medicare |
$6,590.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,590.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$547.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,602.12
|
| Rate for Payer: Healthfirst QHP |
$6,590.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,590.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,590.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,272.58
|
| Rate for Payer: Wellcare Medicare |
$6,261.19
|
|
|
Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s)
|
Facility
OP
|
$4,428.82
|
|
|
Service Code
|
CPT 43264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$387.84 |
| Max. Negotiated Rate |
$4,428.82 |
| 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: 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 |
$387.84
|
| 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 Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$430.93
|
| 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
|
|
|
ENDOSCOPIC US EXAM ESOPH
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43237
|
| Hospital Charge Code |
41112829
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$209.02 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
ENDOSCOPY
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ENDOSCOPY/1
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ENDOSCOPY, BIOPSY
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
41118080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ENDOSCOPY - LIVER BIOPSY
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
41118160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ENDOSCOPY, SCLEROTHERAPY
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
Endoscopy, wrist, surgical, with release of transverse carpal ligament
|
Facility
OP
|
$5,593.00
|
|
|
Service Code
|
CPT 29848
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$581.54 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$581.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| Rate for Payer: Group Health Inc Commercial |
$1,858.61
|
| Rate for Payer: Group Health Inc Medicare |
$1,858.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$646.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
ENDO SHTH TEAR AWAY HLS-1012.5
|
Facility
OP
|
$190.00
|
|
| Hospital Charge Code |
40208006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.00
|
| Rate for Payer: Aetna Government |
$95.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
| Rate for Payer: Group Health Inc Commercial |
$95.00
|
| Rate for Payer: Group Health Inc Medicare |
$66.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
|
|
ENDOSKOPE TUBE SET W/FILTER
|
Facility
OP
|
$15.00
|
|
| Hospital Charge Code |
64906221
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
|
|
ENDOSTEAL IMPLANT
|
Facility
OP
|
$750.00
|
|
|
Service Code
|
HCPCS D6012
|
| Hospital Charge Code |
42303422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$412.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$635.76
|
| Rate for Payer: Aetna Government |
$635.76
|
| 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 |
$375.00
|
| Rate for Payer: Group Health Inc Medicare |
$262.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.00
|
|
|
ENDOSUTURE SYST VICRYL EN3 NDL 0
|
Facility
OP
|
$392.98
|
|
| Hospital Charge Code |
64903131
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.54 |
| Max. Negotiated Rate |
$314.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$196.49
|
| Rate for Payer: Aetna Government |
$196.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$314.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$267.23
|
| Rate for Payer: Group Health Inc Commercial |
$196.49
|
| Rate for Payer: Group Health Inc Medicare |
$137.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.49
|
|
|
ENDOTAK RELIANCE LEAD
|
Facility
OP
|
$11,200.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66574080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.97 |
| Max. Negotiated Rate |
$11,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,160.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,297.97
|
| Rate for Payer: Aetna Government |
$1,297.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,440.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,760.00
|
| Rate for Payer: Group Health Inc Commercial |
$5,600.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,920.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,600.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,280.00
|
|
|
ENDOTAK RELIANCE LEAD
|
Facility
IP
|
$11,200.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
66574080
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,600.00 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,600.00
|
|
