|
ED US URINE CAPACITY MEASURE
|
Facility
OP
|
$165.05
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
41301663
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$49.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$63.67
|
| Rate for Payer: Group Health Inc Medicare |
$63.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
EEG (AWAKE)
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95816 TC
|
| Hospital Charge Code |
41004000
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$268.30 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
| Rate for Payer: Aetna Government |
$383.29
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$363.21
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$403.57
|
|
|
EEG AWAKE AND ASLEEP
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95819 TC
|
| Hospital Charge Code |
30307896
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$268.30 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
| Rate for Payer: Aetna Government |
$383.29
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$430.86
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$478.73
|
|
|
EEG CONT REC W/VID EEG TECH
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95700
|
| Hospital Charge Code |
41001008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$144.51 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
EEG PHY/QHP>36<60 HR W/O VID
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95721
|
| Hospital Charge Code |
41001019
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$236.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$183.76
|
| Rate for Payer: Aetna Government |
$183.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.78
|
|
|
EEG PHY/QHP>36<60 HR W/VEEG
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95722
|
| Hospital Charge Code |
41001020
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$289.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$223.63
|
| Rate for Payer: Aetna Government |
$223.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.11
|
|
|
EEG PHY/QHP>60<84 HR W/O VID
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95723
|
| Hospital Charge Code |
41001021
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$289.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$228.04
|
| Rate for Payer: Aetna Government |
$228.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.41
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.34
|
|
|
EEG PHY/QHP>60<84 HR W/VEEG
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95724
|
| Hospital Charge Code |
41001022
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$364.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$284.99
|
| Rate for Payer: Aetna Government |
$284.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.93
|
|
|
EEG PHY/QHP>84 HR W/O VID
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95725
|
| Hospital Charge Code |
41001023
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$330.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$259.46
|
| Rate for Payer: Aetna Government |
$259.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$297.76
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$330.84
|
|
|
EEG PHY/QHP>84 HR W/VEEG
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95726
|
| Hospital Charge Code |
41001024
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$464.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.20
|
| Rate for Payer: Aetna Government |
$360.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$418.00
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$464.45
|
|
|
EEG PHY/QHP EA INCR W/VEEG
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95720
|
| Hospital Charge Code |
41001018
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$238.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$183.10
|
| Rate for Payer: Aetna Government |
$183.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.39
|
|
|
EEG PHYS/QHP 2-12 HR W/O VID
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95717
|
| Hospital Charge Code |
41001015
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$115.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$89.31
|
| Rate for Payer: Aetna Government |
$89.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.86
|
|
|
EEG PHYS/QHP 2-12 HR W/VEEG
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95718
|
| Hospital Charge Code |
41001016
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$154.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$118.20
|
| Rate for Payer: Aetna Government |
$118.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.01
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
41001017
|
|
Hospital Revenue Code
|
740
|
| Max. Negotiated Rate |
$181.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$139.38
|
| Rate for Payer: Aetna Government |
$139.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$181.23
|
|
|
EEG W/O VID 12-26 HR INTERMIT MON
|
Facility
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95709
|
| Hospital Charge Code |
41001010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$495.86 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
EEG W/O VID 12-26HR UNMONITORED
|
Facility
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95708
|
| Hospital Charge Code |
41001009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$495.86 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
EEG W/O VID 2-12 HR CONT MONITOR
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95707
|
| Hospital Charge Code |
41001004
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$290.38 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
EEG W/O VID 2-12 HR INTERMIT MON
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95706
|
| Hospital Charge Code |
41001003
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$290.38 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
EEG W/O VID 2-12 HR UNATTENDED
|
Facility
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95714
|
| Hospital Charge Code |
41001002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$495.86 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
EEG W/O VID 2-12 HR UNMNTR
|
Facility
OP
|
$814.65
|
|
|
Service Code
|
HCPCS 95705
|
| Hospital Charge Code |
41001011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$290.38 |
| Max. Negotiated Rate |
$651.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$448.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$651.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$553.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
EEG WO VID EA 12-26HR UNMNTR
|
Facility
OP
|
$1,502.55
|
|
|
Service Code
|
HCPCS 95710
|
| Hospital Charge Code |
41001012
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$495.86 |
| Max. Negotiated Rate |
$1,202.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$826.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,202.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,021.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$751.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
EEG W/O VID ONT MONITOR
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95707
|
| Hospital Charge Code |
40111004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$290.38 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
EFAVIRENZ 200 MG CAP
|
Facility
OP
|
$12.65
|
|
| Hospital Charge Code |
41651941
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.32
|
| Rate for Payer: Aetna Government |
$6.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.60
|
| Rate for Payer: Group Health Inc Commercial |
$6.32
|
| Rate for Payer: Group Health Inc Medicare |
$4.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.22
|
|
|
EFAVIRENZ 200 MG CAP
|
Facility
OP
|
$12.65
|
|
| Hospital Charge Code |
41641941
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.32
|
| Rate for Payer: Aetna Government |
$6.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.60
|
| Rate for Payer: Group Health Inc Commercial |
$6.32
|
| Rate for Payer: Group Health Inc Medicare |
$4.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.22
|
|
|
EFAVIRENZ 50 MG CAP
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41641939
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
