|
ECHO EXAM OF EYE THICKNESS
|
Facility
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 76514 TC
|
| Hospital Charge Code |
30305683
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$55.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.82
|
| Rate for Payer: Aetna Government |
$34.82
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.40
|
| Rate for Payer: Group Health Inc Commercial |
$34.82
|
| Rate for Payer: Group Health Inc Medicare |
$24.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.89
|
|
|
ECHO EXAM OF HEART
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
30305400
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$82.36 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.36
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.51
|
|
|
ECHO GUIDE FOR BIOPSY
|
Facility
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
30301275
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.83 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.83
|
| Rate for Payer: Aetna Government |
$46.83
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.80
|
| 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 |
$572.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ECHO INTERPRETATION
|
Facility
OP
|
$1,488.58
|
|
|
Service Code
|
HCPCS 93303 TC
|
| Hospital Charge Code |
30301299
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$1,190.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$818.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$744.29
|
| Rate for Payer: Aetna Government |
$744.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,190.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,012.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.40
|
| Rate for Payer: Group Health Inc Commercial |
$744.29
|
| Rate for Payer: Group Health Inc Medicare |
$521.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$744.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$744.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$198.22
|
|
|
ECHOTHIOPHATE IODIDE 0.125% OPHTHALMIC S
|
Facility
OP
|
$135.00
|
|
| Hospital Charge Code |
41651087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.50
|
| Rate for Payer: Aetna Government |
$67.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.80
|
| Rate for Payer: Group Health Inc Commercial |
$67.50
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.75
|
|
|
ECHOTHIOPHATE IODIDE 0.125% OPHTHALMIC S
|
Facility
OP
|
$135.00
|
|
| Hospital Charge Code |
41641087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.50
|
| Rate for Payer: Aetna Government |
$67.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.80
|
| Rate for Payer: Group Health Inc Commercial |
$67.50
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.75
|
|
|
ECHO TRANSESOPHEGEAL (TEE)
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93318 TC
|
| Hospital Charge Code |
30303079
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$510.50 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
|
|
ECHO TRANSTHORACIC
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93304 TC
|
| Hospital Charge Code |
30101212
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$133.37 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.37
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.19
|
|
|
ECHOVIRUS AB (4,9,11,16)
|
Facility
OP
|
$32.58
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
40728113
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$20.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.60
|
| Rate for Payer: Group Health Inc Commercial |
$13.03
|
| Rate for Payer: Group Health Inc Medicare |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.03
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.42
|
| Rate for Payer: Wellcare Medicare |
$11.73
|
|
|
ECHO W DOPPLER- F/U OR LIMITED ST
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
40804107
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$82.36 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.36
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.51
|
|
|
ECHO WITH BUBBLE SETTING
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
40804115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.61
|
|
|
ECHO WITH COLOR DOPPLER
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
40804106
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.61
|
|
|
ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES
|
Facility
IP
|
$368,180.26
|
|
|
Service Code
|
MS-DRG 003
|
| Min. Negotiated Rate |
$140,887.86 |
| Max. Negotiated Rate |
$368,180.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$314,367.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302,984.65
|
| Rate for Payer: Aetna Government |
$302,984.65
|
| Rate for Payer: Brighton Health Commercial |
$309,144.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$309,044.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$368,180.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$303,838.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$287,835.42
|
| Rate for Payer: EmblemHealth Commercial |
$182,822.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$302,984.65
|
| Rate for Payer: Group Health Inc Commercial |
$302,984.65
|
| Rate for Payer: Group Health Inc Medicare |
$302,984.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302,984.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140,887.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$302,984.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302,984.65
|
| Rate for Payer: Wellcare Medicare |
$287,835.42
|
|
|
ECONAZOLE 1% CREAM 15 GRAMS
|
Facility
OP
|
$5.94
|
|
| Hospital Charge Code |
41654602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna Government |
$2.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.04
|
| Rate for Payer: Group Health Inc Commercial |
$2.97
|
| Rate for Payer: Group Health Inc Medicare |
$2.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.86
|
|
|
ECONAZOLE 1% CREAM 15 GRAMS
|
Facility
OP
|
$5.94
|
|
| Hospital Charge Code |
41644602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna Government |
$2.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.04
|
| Rate for Payer: Group Health Inc Commercial |
$2.97
|
| Rate for Payer: Group Health Inc Medicare |
$2.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.86
|
|
|
ECULIZUMAB 300MG/30ML INJ - NF
|
Facility
IP
|
$509.25
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
41646619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$254.62 |
| Max. Negotiated Rate |
$254.62 |
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.62
|
|
|
ECULIZUMAB 300MG/30ML INJ - NF
|
Facility
IP
|
$509.25
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
41656619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$254.62 |
| Max. Negotiated Rate |
$254.62 |
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.62
|
|
|
ECULIZUMAB 300MG/30ML INJ - NF
|
Facility
OP
|
$509.25
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
41656619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.55 |
| Max. Negotiated Rate |
$331.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$280.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.68
|
| Rate for Payer: Aetna Government |
$225.68
|
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$254.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$292.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$225.68
|
| Rate for Payer: EmblemHealth Commercial |
$225.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$236.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$236.97
|
| Rate for Payer: Group Health Inc Commercial |
$225.68
|
| Rate for Payer: Group Health Inc Medicare |
$225.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.83
|
| Rate for Payer: Healthfirst QHP |
$225.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.25
|
| Rate for Payer: SOMOS Essential |
$239.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$180.55
|
| Rate for Payer: Wellcare Medicare |
$214.40
|
|
|
ECULIZUMAB 300MG/30ML INJ - NF
|
Facility
OP
|
$509.25
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
41646619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.55 |
| Max. Negotiated Rate |
$331.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$280.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.68
|
| Rate for Payer: Aetna Government |
$225.68
|
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$254.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$292.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$225.68
|
| Rate for Payer: EmblemHealth Commercial |
$225.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$236.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$236.97
|
| Rate for Payer: Group Health Inc Commercial |
$225.68
|
| Rate for Payer: Group Health Inc Medicare |
$225.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.83
|
| Rate for Payer: Healthfirst QHP |
$225.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.25
|
| Rate for Payer: SOMOS Essential |
$239.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$180.55
|
| Rate for Payer: Wellcare Medicare |
$214.40
|
|
|
ECXISION OF NECK CYST CONF TO SKI
|
Facility
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 42810
|
| Hospital Charge Code |
40109227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$314.18 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$314.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$349.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
ED BLADDER SONOGRAPHY
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76857 TC
|
| Hospital Charge Code |
41301135
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$28.43 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.43
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.59
|
|
|
ED DETAIL MOD COMPLEX VISIT FEE
|
Facility
OP
|
$1,885.63
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.31 |
| Max. Negotiated Rate |
$942.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$512.19
|
| Rate for Payer: Aetna Government |
$512.19
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$512.19
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$512.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$512.19
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$455.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$512.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$455.85
|
| 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 |
$942.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$512.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$512.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$512.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$512.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$512.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$409.75
|
| Rate for Payer: Wellcare Medicare |
$486.58
|
|
|
ED DETAIL MODERATE COMPLEX
|
Facility
OP
|
$1,885.63
|
|
|
Service Code
|
HCPCS 99284 25
|
| Hospital Charge Code |
30101429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$942.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$942.82
|
| Rate for Payer: Aetna Government |
$942.82
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$942.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$942.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ED DVT
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
41301133
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$173.96 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.96
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.29
|
|
|
ED ECHOCARDIO, TRANSTHOR, REAL
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
41301143
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$82.36 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.36
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.51
|
|
