|
EMERGENCY SERVICE FEE
|
Facility
OP
|
$712.75
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
30100002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.67
|
| Rate for Payer: Aetna Government |
$102.67
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$102.67
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$102.67
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.38
|
| 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 |
$102.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$102.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.14
|
| Rate for Payer: Wellcare Medicare |
$97.54
|
|
|
EMERGENCY TRACHEOSTOMY
|
Facility
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
40013185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$359.72 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$359.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
EMERGENCY TRACHEOTOMY
|
Facility
OP
|
$1,812.50
|
|
|
Service Code
|
HCPCS D7990
|
| Hospital Charge Code |
42302155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.59 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$996.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$451.59
|
| Rate for Payer: Aetna Government |
$451.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$906.25
|
| Rate for Payer: Group Health Inc Medicare |
$634.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$906.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$906.25
|
|
|
EMERSON PUMP UNDWTR DRAIN MAC
|
Facility
OP
|
$49.61
|
|
| Hospital Charge Code |
40200820
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$39.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.80
|
| Rate for Payer: Aetna Government |
$24.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.73
|
| Rate for Payer: Group Health Inc Commercial |
$24.80
|
| Rate for Payer: Group Health Inc Medicare |
$17.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.80
|
|
|
EMESIS BASIN
|
Facility
OP
|
$6.73
|
|
| Hospital Charge Code |
40201480
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
|
EMG ANAL/URETHR SPHINCT NOT NEEDL
|
Facility
OP
|
$406.05
|
|
|
Service Code
|
HCPCS 51784 TC
|
| Hospital Charge Code |
30302041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$223.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$203.02
|
| Rate for Payer: Aetna Government |
$203.02
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| 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: Fidelis CHP/HARP/Medicaid |
$30.64
|
| 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 |
$203.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.05
|
|
|
EMG-SP MUSCLE
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95869 TC
|
| Hospital Charge Code |
30301996
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$84.98 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.98
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.42
|
|
|
EMITRI/RILP/TENO 200-25-300MG TAB
|
Facility
OP
|
$120.89
|
|
| Hospital Charge Code |
41647048
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$96.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60.44
|
| Rate for Payer: Aetna Government |
$60.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.21
|
| Rate for Payer: Group Health Inc Commercial |
$60.44
|
| Rate for Payer: Group Health Inc Medicare |
$42.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.58
|
|
|
EMPTY SCREW DISC FOR 1.7 MM
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.00
|
|
|
EMPTY SCREW DISC FOR 1.7 MM
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201334
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$596.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$312.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$284.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$326.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$596.40
|
| Rate for Payer: Group Health Inc Commercial |
$284.00
|
| Rate for Payer: Group Health Inc Medicare |
$198.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$369.20
|
|
|
EMTRICITABINE 200 MG CAP
|
Facility
OP
|
$27.73
|
|
| Hospital Charge Code |
41643207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.86
|
| Rate for Payer: Aetna Government |
$13.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.86
|
| Rate for Payer: Group Health Inc Commercial |
$13.86
|
| Rate for Payer: Group Health Inc Medicare |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.02
|
|
|
EMTRICITABINE 200 MG CAP
|
Facility
OP
|
$27.73
|
|
| Hospital Charge Code |
41653207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.86
|
| Rate for Payer: Aetna Government |
$13.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.86
|
| Rate for Payer: Group Health Inc Commercial |
$13.86
|
| Rate for Payer: Group Health Inc Medicare |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.02
|
|
|
EMTRICITABINE TENOF EFAVRIENZ TAB
|
Facility
OP
|
$114.40
|
|
| Hospital Charge Code |
41647004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$91.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.20
|
| Rate for Payer: Aetna Government |
$57.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$91.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.79
|
| Rate for Payer: Group Health Inc Commercial |
$57.20
|
| Rate for Payer: Group Health Inc Medicare |
$40.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.36
|
|
|
EMTRICITABINE-TENOFOVIR 100-150MG
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41640353
|
|
Hospital Revenue Code
|
250
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
EMTRICITABINE-TENOFOVIR 100-150MG
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41650353
|
|
Hospital Revenue Code
|
250
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
EMTRICITABINE-TENOFOVIR 133-200MG
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41640354
|
|
Hospital Revenue Code
|
250
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
EMTRICITABINE-TENOFOVIR 133-200MG
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41650354
|
|
Hospital Revenue Code
|
250
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
EMTRICITABINE-TENOFOVIR 167-250MG
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41650355
|
|
Hospital Revenue Code
|
250
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
EMTRICITABINE-TENOFOVIR 167-250MG
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41640355
|
|
Hospital Revenue Code
|
250
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
EMTRICITAB/TENOFOVIR ALAF 200-25
|
Facility
OP
|
$122.13
|
|
| Hospital Charge Code |
41656639
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$97.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.06
|
| Rate for Payer: Aetna Government |
$61.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.05
|
| Rate for Payer: Group Health Inc Commercial |
$61.06
|
| Rate for Payer: Group Health Inc Medicare |
$42.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.38
|
|
|
EMTRICITAB/TENOFOVIR ALAF 200-25
|
Facility
OP
|
$122.13
|
|
| Hospital Charge Code |
41646639
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$97.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.06
|
| Rate for Payer: Aetna Government |
$61.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.05
|
| Rate for Payer: Group Health Inc Commercial |
$61.06
|
| Rate for Payer: Group Health Inc Medicare |
$42.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.38
|
|
|
EMTRI/RILP/TENO 200-25-300MG TAB
|
Facility
OP
|
$120.89
|
|
| Hospital Charge Code |
41657048
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.31 |
| Max. Negotiated Rate |
$96.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60.44
|
| Rate for Payer: Aetna Government |
$60.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.21
|
| Rate for Payer: Group Health Inc Commercial |
$60.44
|
| Rate for Payer: Group Health Inc Medicare |
$42.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.58
|
|
|
EMTRI/TENOF/EFAV 200/300/600MGTAB
|
Facility
OP
|
$114.40
|
|
| Hospital Charge Code |
41657004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$91.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.20
|
| Rate for Payer: Aetna Government |
$57.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$91.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.79
|
| Rate for Payer: Group Health Inc Commercial |
$57.20
|
| Rate for Payer: Group Health Inc Medicare |
$40.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.36
|
|
|
ENALAPRIL 10 MG TAB
|
Facility
OP
|
$0.11
|
|
| Hospital Charge Code |
41642936
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
ENALAPRIL 10 MG TAB
|
Facility
OP
|
$0.11
|
|
| Hospital Charge Code |
41652936
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
