|
EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
42500131
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$923.79 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Brighton Health Commercial |
$1,385.68
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,874.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
42500131
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,874.89
|
|
|
EXPLOR LAP-CLOSE ABDOMNL WND
|
Facility
|
OP
|
$2,568.20
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
40010880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$898.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$912.81
|
| Rate for Payer: Aetna Government |
$912.81
|
| Rate for Payer: Brighton Health Commercial |
$1,926.15
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,284.10
|
| Rate for Payer: Group Health Inc Medicare |
$898.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,284.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,284.10
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
EXPLOR LAP-CLOSE PERF ULCER
|
Facility
|
OP
|
$4,583.88
|
|
|
Service Code
|
HCPCS 43840
|
| Hospital Charge Code |
40010885
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,316.45 |
| Max. Negotiated Rate |
$3,437.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,521.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,316.45
|
| Rate for Payer: Aetna Government |
$1,316.45
|
| Rate for Payer: Brighton Health Commercial |
$3,437.91
|
| 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
|
| Rate for Payer: Group Health Inc Commercial |
$2,291.94
|
| Rate for Payer: Group Health Inc Medicare |
$1,604.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,291.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,291.94
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
EXPLOR LAP-INSERT GAST. TUBE
|
Facility
|
IP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43830
|
| Hospital Charge Code |
40010905
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,200.46
|
|
|
EXPLOR LAP-INSERT GAST. TUBE
|
Facility
|
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43830
|
| Hospital Charge Code |
40010905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,537.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$3,537.74
|
| 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 |
$1,468.00
|
| 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
|
|
|
EXPLOR LAP-LIGATION BLEEDER
|
Facility
|
OP
|
$4,537.05
|
|
|
Service Code
|
HCPCS 43501
|
| Hospital Charge Code |
40010910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$3,402.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,495.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,598.00
|
| Rate for Payer: Aetna Government |
$1,598.00
|
| Rate for Payer: Brighton Health Commercial |
$3,402.79
|
| 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
|
| Rate for Payer: Group Health Inc Commercial |
$2,268.52
|
| Rate for Payer: Group Health Inc Medicare |
$1,587.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,268.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,268.52
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
EXPLOR LAP-LYSIS OF ADHESNS
|
Facility
|
OP
|
$3,669.80
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
40010915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,284.43 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,018.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,298.66
|
| Rate for Payer: Aetna Government |
$1,298.66
|
| Rate for Payer: Brighton Health Commercial |
$2,752.35
|
| 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
|
| Rate for Payer: Group Health Inc Commercial |
$1,834.90
|
| Rate for Payer: Group Health Inc Medicare |
$1,284.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,834.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,834.90
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
EXPLOR LAP-REPR LESION, COLON
|
Facility
|
OP
|
$3,532.08
|
|
|
Service Code
|
HCPCS 44604
|
| Hospital Charge Code |
40010920
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,236.23 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,942.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,253.85
|
| Rate for Payer: Aetna Government |
$1,253.85
|
| Rate for Payer: Brighton Health Commercial |
$2,649.06
|
| 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
|
| Rate for Payer: Group Health Inc Commercial |
$1,766.04
|
| Rate for Payer: Group Health Inc Medicare |
$1,236.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,766.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,766.04
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
EXPLOR LAP - SALPINGECTOMY
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
40052230
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
|
EXPLOR LAP - SALPINGECTOMY
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 58661
|
| Hospital Charge Code |
40052230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$10,980.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| 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
|
|
|
EXPLOR LAP-VGTMY, PYLORPLSTY
|
Facility
|
OP
|
$3,239.70
|
|
|
Service Code
|
HCPCS 43640
|
| Hospital Charge Code |
40010925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,133.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,781.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,401.25
|
| Rate for Payer: Aetna Government |
$1,401.25
|
| Rate for Payer: Brighton Health Commercial |
$2,429.78
|
| 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
|
| Rate for Payer: Group Health Inc Commercial |
$1,619.85
|
| Rate for Payer: Group Health Inc Medicare |
$1,133.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,619.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,619.85
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
EXPLOR-SCROTAL EPIDIDYMITIS
|
Facility
|
OP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
40122995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,856.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$1,468.00
|
| 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
|
|
|
EXPLOR-SCROTAL EPIDIDYMITIS
|
Facility
|
IP
|
$9,142.40
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
40122995
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,031.47
|
|
|
EXPLORTRY LAP-APPENDECTOMY
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
40010855
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$10,980.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| 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
|
|
|
EXPLORTRY LAP-APPENDECTOMY
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
40010855
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
|
EXPLRTRY LAP-BOWEL RESECTION
|
Facility
|
OP
|
$4,205.72
|
|
|
Service Code
|
HCPCS 44202
|
| Hospital Charge Code |
40010875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,472.00 |
| Max. Negotiated Rate |
$3,154.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,313.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,646.66
|
| Rate for Payer: Aetna Government |
$1,646.66
|
| Rate for Payer: Brighton Health Commercial |
$3,154.29
|
| 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
|
| Rate for Payer: Group Health Inc Commercial |
$2,102.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,472.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,102.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,102.86
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
|
|
EXPLRTRY LAP-BX ABDOMNL MASS
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
40010860
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
|
EXPLRTRY LAP-BX ABDOMNL MASS
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 49321
|
| Hospital Charge Code |
40010860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$10,980.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$2,683.00
|
| 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
|
|
|
EXT CEPHALIC VERSION
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
40052244
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
EXT CEPHALIC VERSION
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
30102502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$3,687.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$79.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35.35
|
| Rate for Payer: Amida Care Medicaid |
$35.35
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,535.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.12
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.35
|
| Rate for Payer: Healthfirst Essential Plan |
$79.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$35.35
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.35
|
| Rate for Payer: SOMOS Essential |
$35.35
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$79.54
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$38.88
|
| Rate for Payer: United Healthcare Medicaid |
$35.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
EXT CEPHALIC VERSION
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
40052244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$79.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35.35
|
| Rate for Payer: Amida Care Medicaid |
$35.35
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,535.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.12
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.35
|
| Rate for Payer: Healthfirst Essential Plan |
$79.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$35.35
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.35
|
| Rate for Payer: SOMOS Essential |
$35.35
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$79.54
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$38.88
|
| Rate for Payer: United Healthcare Medicaid |
$35.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
EXT CEPHALIC VERSION
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
30102502
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
EXTENDED BATHBRUSH
|
Facility
|
OP
|
$17.01
|
|
| Hospital Charge Code |
40201518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.50
|
| Rate for Payer: Aetna Government |
$8.50
|
| Rate for Payer: Brighton Health Commercial |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.57
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
|
|
EXTENDED LOCAL ANESTHESIA MARCAIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS D9613
|
| Hospital Charge Code |
42300756
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.77
|
| Rate for Payer: Aetna Government |
$6.77
|
| Rate for Payer: Brighton Health Commercial |
$37.50
|
| 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 |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
