|
ELETRIPTAN 40 MG TAB
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
41644367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.50
|
| Rate for Payer: Aetna Government |
$24.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.32
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
|
|
ELETRIPTAN 40 MG TAB
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
41654367
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.50
|
| Rate for Payer: Aetna Government |
$24.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.32
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
|
|
ELEV BP PLAN OF CARE DOCD
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 0513F
|
| Hospital Charge Code |
30300377
|
|
Hospital Revenue Code
|
969
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| 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
|
|
|
ELLA 30 MG TAB
|
Facility
OP
|
$34.46
|
|
| Hospital Charge Code |
41648031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$27.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.23
|
| Rate for Payer: Aetna Government |
$17.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.43
|
| Rate for Payer: Group Health Inc Commercial |
$17.23
|
| Rate for Payer: Group Health Inc Medicare |
$12.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.40
|
|
|
ELLA 30MG TAB
|
Facility
OP
|
$34.46
|
|
| Hospital Charge Code |
41658031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$27.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.23
|
| Rate for Payer: Aetna Government |
$17.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.43
|
| Rate for Payer: Group Health Inc Commercial |
$17.23
|
| Rate for Payer: Group Health Inc Medicare |
$12.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.40
|
|
|
ELOTUZUMAB 300MG/12ML INJECTION
|
Facility
IP
|
$15.48
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
41647834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.74
|
|
|
ELOTUZUMAB 300MG/12ML INJECTION
|
Facility
OP
|
$15.48
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
41647834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$10.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.38
|
| Rate for Payer: Aetna Government |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.38
|
| Rate for Payer: EmblemHealth Commercial |
$7.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.75
|
| Rate for Payer: Group Health Inc Commercial |
$7.38
|
| Rate for Payer: Group Health Inc Medicare |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.27
|
| Rate for Payer: Healthfirst QHP |
$7.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.85
|
| Rate for Payer: SOMOS Essential |
$7.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.90
|
| Rate for Payer: Wellcare Medicare |
$7.01
|
|
|
ELOTUZUMAB 300MG/12ML INJECTION
|
Facility
OP
|
$15.48
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
41657834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$10.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.38
|
| Rate for Payer: Aetna Government |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.38
|
| Rate for Payer: EmblemHealth Commercial |
$7.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.75
|
| Rate for Payer: Group Health Inc Commercial |
$7.38
|
| Rate for Payer: Group Health Inc Medicare |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.27
|
| Rate for Payer: Healthfirst QHP |
$7.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.85
|
| Rate for Payer: SOMOS Essential |
$7.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.90
|
| Rate for Payer: Wellcare Medicare |
$7.01
|
|
|
ELOTUZUMAB 300MG/12ML INJECTION
|
Facility
IP
|
$15.48
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
41657834
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.74
|
|
|
ELOTUZUMAB 400MG/16ML INJECTION
|
Facility
OP
|
$15.48
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
41647835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$10.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.38
|
| Rate for Payer: Aetna Government |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.38
|
| Rate for Payer: EmblemHealth Commercial |
$7.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.75
|
| Rate for Payer: Group Health Inc Commercial |
$7.38
|
| Rate for Payer: Group Health Inc Medicare |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.27
|
| Rate for Payer: Healthfirst QHP |
$7.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.85
|
| Rate for Payer: SOMOS Essential |
$7.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.90
|
| Rate for Payer: Wellcare Medicare |
$7.01
|
|
|
ELOTUZUMAB 400MG/16ML INJECTION
|
Facility
IP
|
$15.48
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
41647835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.74
|
|
|
ELOTUZUMAB 400MG/16ML INJECTION
|
Facility
OP
|
$15.48
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
41657835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$10.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.38
|
| Rate for Payer: Aetna Government |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.38
|
| Rate for Payer: EmblemHealth Commercial |
$7.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.75
|
| Rate for Payer: Group Health Inc Commercial |
$7.38
|
| Rate for Payer: Group Health Inc Medicare |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.27
|
| Rate for Payer: Healthfirst QHP |
$7.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.85
|
| Rate for Payer: SOMOS Essential |
$7.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.90
|
| Rate for Payer: Wellcare Medicare |
$7.01
|
|
|
ELOTUZUMAB 400MG/16ML INJECTION
|
Facility
IP
|
$15.48
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
41657835
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Cash Price |
$7.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.74
|
|
|
ELVET/COBIC/EMTRICITAB/TENOF
|
Facility
OP
|
$156.00
|
|
| Hospital Charge Code |
41646500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.00
|
| Rate for Payer: Aetna Government |
$78.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$106.08
|
| Rate for Payer: Group Health Inc Commercial |
$78.00
|
| Rate for Payer: Group Health Inc Medicare |
$54.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.40
|
|
|
ELVET/COBIC/EMTRICITAB/TENOF
|
Facility
OP
|
$156.00
|
|
| Hospital Charge Code |
41656500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.00
|
| Rate for Payer: Aetna Government |
$78.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$106.08
|
| Rate for Payer: Group Health Inc Commercial |
$78.00
|
| Rate for Payer: Group Health Inc Medicare |
$54.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.40
|
|
|
ELVIT/COBIC/EMTRIC/TENOF TAB
|
Facility
OP
|
$213.62
|
|
| Hospital Charge Code |
41646631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.77 |
| Max. Negotiated Rate |
$170.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$106.81
|
| Rate for Payer: Aetna Government |
$106.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$170.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$145.26
|
| Rate for Payer: Group Health Inc Commercial |
$106.81
|
| Rate for Payer: Group Health Inc Medicare |
$74.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.85
|
|
|
ELVIT/COBIC/EMTRIC/TENOF TAB
|
Facility
OP
|
$213.62
|
|
| Hospital Charge Code |
41656631
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.77 |
| Max. Negotiated Rate |
$170.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$106.81
|
| Rate for Payer: Aetna Government |
$106.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$170.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$145.26
|
| Rate for Payer: Group Health Inc Commercial |
$106.81
|
| Rate for Payer: Group Health Inc Medicare |
$74.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.85
|
|
|
EM ABLATION, THEMAL, W/O
|
Facility
OP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
30301266
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$6,468.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,751.94
|
| Rate for Payer: Aetna Government |
$5,751.94
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,751.94
|
| 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 |
$5,751.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$259.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,889.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,119.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,751.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,119.23
|
| 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 |
$6,468.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,751.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$288.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,889.15
|
| Rate for Payer: Healthfirst QHP |
$5,751.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,751.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,751.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,751.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,601.55
|
| Rate for Payer: Wellcare Medicare |
$5,464.34
|
|
|
EMBOZENE MICROSH 900 2ML
|
Facility
OP
|
$412.50
|
|
| Hospital Charge Code |
64903551
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$206.25
|
| Rate for Payer: Aetna Government |
$206.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
| Rate for Payer: Group Health Inc Commercial |
$206.25
|
| Rate for Payer: Group Health Inc Medicare |
$144.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
|
|
EMBOZENE MICROSP 500 UM 2ML
|
Facility
OP
|
$412.50
|
|
| Hospital Charge Code |
64903558
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$206.25
|
| Rate for Payer: Aetna Government |
$206.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
| Rate for Payer: Group Health Inc Commercial |
$206.25
|
| Rate for Payer: Group Health Inc Medicare |
$144.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
|
|
EMBOZENE MICROSPH 700 UM 2ML
|
Facility
OP
|
$412.50
|
|
| Hospital Charge Code |
64903556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$206.25
|
| Rate for Payer: Aetna Government |
$206.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
| Rate for Payer: Group Health Inc Commercial |
$206.25
|
| Rate for Payer: Group Health Inc Medicare |
$144.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
|
|
EMENTECTOMY
|
Facility
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 41820
|
| Hospital Charge Code |
40011275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 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 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
|
|
|
EMERGENCY INTUBATION ENDOTRACHEAL
|
Facility
OP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
30300035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$311.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
EMERGENCY INTUBATION ENDOTRACHEAL
|
Facility
OP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
30103035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$311.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
EMERGENCY INTUBATION ENDOTRACHEAL
|
Facility
OP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
40000352
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| Rate for Payer: Group Health Inc Commercial |
$282.47
|
| Rate for Payer: Group Health Inc Medicare |
$282.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
