|
EDETATE CALCIUM DISODIUM 200 MG/ML INJ
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
HCPCS J0600
|
| Hospital Charge Code |
41651401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.00
|
|
|
EDETATE CALCIUM DISODIUM 200 MG/ML INJ
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
HCPCS J0600
|
| Hospital Charge Code |
41641401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$6,775.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,452.50
|
| Rate for Payer: Aetna Government |
$6,452.50
|
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,452.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$94.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,452.50
|
| Rate for Payer: EmblemHealth Commercial |
$6,452.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,452.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,452.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,775.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,452.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,775.12
|
| Rate for Payer: Group Health Inc Commercial |
$6,452.50
|
| Rate for Payer: Group Health Inc Medicare |
$6,452.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,484.62
|
| Rate for Payer: Healthfirst QHP |
$6,452.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,452.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,162.00
|
| Rate for Payer: Wellcare Medicare |
$6,129.87
|
|
|
EDETATE CALCIUM DISODIUM 200 MG/ML INJ
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
HCPCS J0600
|
| Hospital Charge Code |
41651401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$6,775.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,452.50
|
| Rate for Payer: Aetna Government |
$6,452.50
|
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,452.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$94.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,452.50
|
| Rate for Payer: EmblemHealth Commercial |
$6,452.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,452.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,452.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,775.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,452.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,775.12
|
| Rate for Payer: Group Health Inc Commercial |
$6,452.50
|
| Rate for Payer: Group Health Inc Medicare |
$6,452.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,484.62
|
| Rate for Payer: Healthfirst QHP |
$6,452.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,452.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,162.00
|
| Rate for Payer: Wellcare Medicare |
$6,129.87
|
|
|
EDETATE CALCIUM DISODIUM 200 MG/ML INJ
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
HCPCS J0600
|
| Hospital Charge Code |
41641401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.00
|
|
|
ED HIGH COMPLEX
|
Facility
OP
|
$3,480.31
|
|
|
Service Code
|
HCPCS 99285 25
|
| Hospital Charge Code |
30101431
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,740.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,740.16
|
| Rate for Payer: Aetna Government |
$1,740.16
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| 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 |
$1,740.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,740.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ED HIGH COMPLEXITY VISIT FEE
|
Facility
OP
|
$3,480.31
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
30100007
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,740.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$742.78
|
| Rate for Payer: Aetna Government |
$742.78
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$742.78
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$742.78
|
| 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 |
$742.78
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$631.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$661.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$661.07
|
| 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 |
$1,740.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$742.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$742.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$742.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$594.22
|
| Rate for Payer: Wellcare Medicare |
$705.64
|
|
|
ED LOW COMPLEXITY
|
Facility
OP
|
$979.88
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
30100003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$44.75 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.13
|
| Rate for Payer: Aetna Government |
$189.13
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$189.13
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.13
|
| 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 |
$189.13
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.33
|
| 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 |
$489.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$189.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$151.30
|
| Rate for Payer: Wellcare Medicare |
$179.67
|
|
|
ED LOW COMPLEXITY -
|
Facility
OP
|
$979.88
|
|
|
Service Code
|
HCPCS 99282 25
|
| Hospital Charge Code |
30101427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$489.94
|
| Rate for Payer: Aetna Government |
$489.94
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| 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 |
$489.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ED LOW COMPLXITY
|
Facility
OP
|
$340.04
|
|
|
Service Code
|
HCPCS 99282 95
|
| Hospital Charge Code |
30100349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$170.02
|
| Rate for Payer: Aetna Government |
$170.02
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| 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 |
$170.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ED MODERATE COMPLEX
|
Facility
OP
|
$1,246.36
|
|
|
Service Code
|
HCPCS 99283 25
|
| Hospital Charge Code |
30101428
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$623.18
|
| Rate for Payer: Aetna Government |
$623.18
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| 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 |
$623.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$623.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ED MODERATE COMPLEXITY
|
Facility
OP
|
$435.95
|
|
|
Service Code
|
HCPCS 99283 95
|
| Hospital Charge Code |
30100350
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$217.98
|
| Rate for Payer: Aetna Government |
$217.98
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| 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 |
$217.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ED MODERATE COMPLEXITY
|
Facility
OP
|
$1,246.36
|
|
|
Service Code
|
HCPCS 99283
|
| Hospital Charge Code |
30100004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.13 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$329.95
|
| Rate for Payer: Aetna Government |
$329.95
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$329.95
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$329.95
|
| 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 |
$329.95
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$293.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$293.66
|
| 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 |
$623.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$329.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$329.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$329.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$329.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$329.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$263.96
|
| Rate for Payer: Wellcare Medicare |
$313.45
|
|
|
ED OCULAR FOREIGN BODY
|
Facility
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 76529 TC
|
| Hospital Charge Code |
41301123
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$60.22 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$120.86
|
| Rate for Payer: Aetna Government |
$120.86
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.22
|
| Rate for Payer: Group Health Inc Commercial |
$120.86
|
| Rate for Payer: Group Health Inc Medicare |
$84.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.91
|
|
|
ED OPH US D X B-SCAN
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76512
|
| Hospital Charge Code |
41301662
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
ED POST-VOID RESIDUAL
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76857 TC
|
| Hospital Charge Code |
41301139
|
|
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
|
|
|
EDROPHONIUM 10 MG/ML INJ
|
Facility
OP
|
$81.66
|
|
| Hospital Charge Code |
41655188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.58 |
| Max. Negotiated Rate |
$65.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.83
|
| Rate for Payer: Aetna Government |
$40.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.53
|
| Rate for Payer: Group Health Inc Commercial |
$40.83
|
| Rate for Payer: Group Health Inc Medicare |
$28.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.08
|
|
|
EDROPHONIUM 10 MG/ML INJ
|
Facility
OP
|
$81.66
|
|
| Hospital Charge Code |
41645188
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.58 |
| Max. Negotiated Rate |
$65.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.83
|
| Rate for Payer: Aetna Government |
$40.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.53
|
| Rate for Payer: Group Health Inc Commercial |
$40.83
|
| Rate for Payer: Group Health Inc Medicare |
$28.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.08
|
|
|
ED SOFT TISSUE AILLA
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76882 TC
|
| Hospital Charge Code |
41301127
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$10.68 |
| 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 |
$10.68
|
| 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 |
$11.87
|
|
|
ED SOFT TISSUE AXILLA
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76882 TC
|
| Hospital Charge Code |
41300921
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$10.68 |
| 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 |
$10.68
|
| 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 |
$11.87
|
|
|
ED SOFT TISSUE NECK
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76536 TC
|
| Hospital Charge Code |
41301125
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.22 |
| 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 |
$94.22
|
| 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 |
$104.69
|
|
|
ED STRAIGHT FWD MED. DECISION
|
Facility
OP
|
$712.75
|
|
|
Service Code
|
HCPCS 99281 25
|
| Hospital Charge Code |
30101426
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$356.38
|
| Rate for Payer: Aetna Government |
$356.38
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| 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 |
$356.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$356.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ED STRAIGHT FWD MEDICAL DECISION
|
Facility
OP
|
$340.04
|
|
|
Service Code
|
HCPCS 99281 95
|
| Hospital Charge Code |
30100348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$170.02
|
| Rate for Payer: Aetna Government |
$170.02
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| 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 |
$170.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ED THORACIC
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76604 TC
|
| Hospital Charge Code |
41301141
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.86 |
| 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 |
$32.86
|
| 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 |
$36.51
|
|
|
ED THORACIC-US EXAM CHEST
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76604 TC
|
| Hospital Charge Code |
41303340
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.86 |
| 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 |
$32.86
|
| 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 |
$36.51
|
|
|
ED & TRAIN, 2-4 PTS
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 98961
|
| Hospital Charge Code |
30105455
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.24
|
| Rate for Payer: Aetna Government |
$12.24
|
| Rate for Payer: Amida Care Medicaid |
$20.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,040.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.42
|
| 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 |
$20.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.40
|
| Rate for Payer: Healthfirst Essential Plan |
$45.90
|
| Rate for Payer: Healthfirst QHP |
$20.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.40
|
| Rate for Payer: SOMOS Essential |
$45.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.40
|
|
