|
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 |
$1,505.00 |
| Max. Negotiated Rate |
$6,856.80 |
| 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: Affinity Essential Plan 1&2 |
$2,822.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,822.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,822.03
|
| Rate for Payer: Brighton Health Commercial |
$6,856.80
|
| 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 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 Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Humana Medicare |
$4,112.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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 INJECTION/IMPLANT
|
Facility
|
IP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 51715
|
| Hospital Charge Code |
40123276
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,031.47
|
|
|
Endoscopic plantar fasciotomy
|
Facility
|
OP
|
$5,593.00
|
|
|
Service Code
|
CPT 29893
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| 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: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| 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 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 Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
$6,722.54
|
|
|
Service Code
|
CPT 43274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,722.54 |
| 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: Affinity Essential Plan 1&2 |
$4,613.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,613.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,613.51
|
| 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 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 Medicare Advantage |
$5,602.12
|
| Rate for Payer: Healthfirst QHP |
$6,590.73
|
| Rate for Payer: Humana Medicare |
$6,722.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,590.73
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare 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
|
$4,517.40
|
|
|
Service Code
|
CPT 43264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$4,517.40 |
| 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: 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 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
|
|
|
ENDOSCOPIC US EXAM ESOPH
|
Facility
|
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43237
|
| Hospital Charge Code |
41112829
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$955.00 |
| 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: Affinity Essential Plan 1&2 |
$1,540.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,540.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,540.32
|
| 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 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 Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Humana Medicare |
$2,244.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare 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
|
|
|
ENDOSCOPIC US EXAM ESOPH
|
Facility
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43237
|
| Hospital Charge Code |
41112829
|
|
Hospital Revenue Code
|
750
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
|
ENDOSCOPY
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.80 |
| 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: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| 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 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 Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare 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
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118000
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
ENDOSCOPY/1
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118070
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
ENDOSCOPY/1
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118070
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.80 |
| 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: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| 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 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 Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
41118080
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
ENDOSCOPY, BIOPSY
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
41118080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.80 |
| 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: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| 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 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 Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
41118160
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
ENDOSCOPY - LIVER BIOPSY
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
41118160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.80 |
| 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: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| 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 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 Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare 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 |
$733.80 |
| 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: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| 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 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 Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare 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
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43235
|
| Hospital Charge Code |
41118090
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
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 |
$1,301.03 |
| 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: Affinity Essential Plan 1&2 |
$1,301.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,301.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,301.03
|
| 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 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 Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Humana Medicare |
$1,895.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare 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: Brighton Health Commercial |
$142.50
|
| 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: Brighton Health Commercial |
$11.25
|
| 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: Brighton Health Commercial |
$562.50
|
| 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: Brighton Health Commercial |
$294.74
|
| 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
|
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
|
|
|
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: Brighton Health Commercial |
$6,720.00
|
| 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: EmblemHealth Commercial |
$5,600.00
|
| 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
|
|
