|
END CAP-PED FEMORAL NAIL
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.00
|
|
|
END CAP-PED FEMORAL NAIL
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202045
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$550.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$288.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$314.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$262.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$301.30
|
| Rate for Payer: EmblemHealth Commercial |
$262.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$550.20
|
| Rate for Payer: Group Health Inc Commercial |
$262.00
|
| Rate for Payer: Group Health Inc Medicare |
$183.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$340.60
|
|
|
END CAP REMOVAL TOOL
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$158.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$172.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.60
|
| Rate for Payer: EmblemHealth Commercial |
$144.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$302.40
|
| Rate for Payer: Group Health Inc Commercial |
$144.00
|
| Rate for Payer: Group Health Inc Medicare |
$100.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.20
|
|
|
END CAP REMOVAL TOOL
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.00
|
|
|
ENDCAP SMALL ROUND 12MM
|
Facility
|
OP
|
$382.87
|
|
| Hospital Charge Code |
64906233
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$306.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.44
|
| Rate for Payer: Aetna Government |
$191.44
|
| Rate for Payer: Brighton Health Commercial |
$287.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.35
|
| Rate for Payer: Group Health Inc Commercial |
$191.44
|
| Rate for Payer: Group Health Inc Medicare |
$134.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.44
|
|
|
ENDCAP SMALL ROUND 16MM
|
Facility
|
OP
|
$382.87
|
|
| Hospital Charge Code |
64906231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$306.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.44
|
| Rate for Payer: Aetna Government |
$191.44
|
| Rate for Payer: Brighton Health Commercial |
$287.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.35
|
| Rate for Payer: Group Health Inc Commercial |
$191.44
|
| Rate for Payer: Group Health Inc Medicare |
$134.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.44
|
|
|
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: Brighton Health Commercial |
$1,989.32
|
| 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
|
IP
|
$814.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
30303082
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$370.99
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 57456
|
| Hospital Charge Code |
30303082
|
|
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
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$1,933.73
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
30300092
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$929.66
|
|
|
ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$1,933.73
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
30300092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$650.76 |
| 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 |
$1,450.30
|
| 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 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 Medicare Advantage |
$790.21
|
| Rate for Payer: Healthfirst QHP |
$929.66
|
| Rate for Payer: Humana Medicare |
$948.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.66
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| 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
|
|
|
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: Brighton Health Commercial |
$10.50
|
| 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
|
IP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43277
|
| Hospital Charge Code |
40019917
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,428.82
|
|
|
ENDO CHOLANGIO/BALLOON DILATION
|
Facility
|
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43277
|
| Hospital Charge Code |
40019917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,812.61 |
| 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: Affinity Essential Plan 1&2 |
$3,100.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,100.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,100.17
|
| Rate for Payer: Brighton Health Commercial |
$6,812.61
|
| 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 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 Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Humana Medicare |
$4,517.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
41118920
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,428.82
|
|
|
ENDO CHOLANGIOPANCREATOGRAPHY
|
Facility
|
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
41118920
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| 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: Affinity Essential Plan 1&2 |
$3,100.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,100.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,100.17
|
| 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 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 Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Humana Medicare |
$4,517.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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 |
$955.00 |
| 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: Affinity Essential Plan 1&2 |
$3,100.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,100.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,100.17
|
| 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 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 Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Humana Medicare |
$4,517.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
40014232
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,428.82
|
|
|
ENDO CHOLANGIO W SPHINECTEROTOMY
|
Facility
|
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
41114205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| 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: Affinity Essential Plan 1&2 |
$3,100.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,100.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,100.17
|
| 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 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 Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Humana Medicare |
$4,517.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43262
|
| Hospital Charge Code |
41114205
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,428.82
|
|
|
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 |
$10,980.08 |
| 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: Affinity Essential Plan 1&2 |
$4,670.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,670.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,670.77
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| 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: Humana Medicare |
$6,805.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare 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
|
|
|
ENDOCHRINE SURGERY PROCEDURE
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 60699
|
| Hospital Charge Code |
40014090
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
|
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: Brighton Health Commercial |
$183.25
|
| 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
|
$30,319.90
|
|
|
Service Code
|
MSDRG 644
|
| Min. Negotiated Rate |
$9,104.08 |
| Max. Negotiated Rate |
$30,319.90 |
| 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: Humana Medicare |
$30,319.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,050.84
|
| Rate for Payer: United Healthcare Commercial |
$21,114.03
|
| Rate for Payer: United Healthcare 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
|
$41,443.98
|
|
|
Service Code
|
MSDRG 643
|
| Min. Negotiated Rate |
$14,015.60 |
| Max. Negotiated Rate |
$41,443.98 |
| 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: Humana Medicare |
$41,443.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,141.08
|
| Rate for Payer: United Healthcare Commercial |
$32,716.10
|
| Rate for Payer: United Healthcare 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
|
|
