|
EP INS ELEC LV W/PRE IMPLNT
|
Facility
OP
|
$35.75
|
|
|
Service Code
|
HCPCS 33224
|
| Hospital Charge Code |
66575418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| Rate for Payer: Aetna Government |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,348.58
|
| 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 |
$12,348.58
|
| Rate for Payer: EmblemHealth Commercial |
$12,348.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$582.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,496.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,990.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,348.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,990.24
|
| Rate for Payer: Group Health Inc Commercial |
$12,348.58
|
| Rate for Payer: Group Health Inc Medicare |
$12,348.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$647.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,496.29
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,348.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,878.86
|
| Rate for Payer: Wellcare Medicare |
$11,731.15
|
|
|
EP INS ELEC SNG CHMB/ICD
|
Facility
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33216
|
| Hospital Charge Code |
66574512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$422.72 |
| Max. Negotiated Rate |
$11,572.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,824.59
|
| Rate for Payer: Aetna Government |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,824.59
|
| 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: Elderplan Medicare Advantage |
$9,824.59
|
| Rate for Payer: EmblemHealth Commercial |
$9,824.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$422.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,350.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,743.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,824.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,743.89
|
| Rate for Payer: Group Health Inc Commercial |
$9,824.59
|
| Rate for Payer: Group Health Inc Medicare |
$9,824.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,824.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$469.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,350.90
|
| Rate for Payer: Healthfirst QHP |
$9,824.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,824.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,824.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,859.67
|
| Rate for Payer: Wellcare Medicare |
$9,333.36
|
|
|
EP INS ICD W/EX DUAL LEAD
|
Facility
OP
|
$68,791.68
|
|
|
Service Code
|
HCPCS 33230
|
| Hospital Charge Code |
66574524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$434.38 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,258.51
|
| Rate for Payer: Aetna Government |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,258.51
|
| 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 |
$27,258.51
|
| Rate for Payer: EmblemHealth Commercial |
$27,258.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$434.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23,169.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24,260.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,258.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,260.07
|
| Rate for Payer: Group Health Inc Commercial |
$27,258.51
|
| Rate for Payer: Group Health Inc Medicare |
$27,258.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,395.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,258.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$482.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,169.73
|
| Rate for Payer: Healthfirst QHP |
$27,258.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,258.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,258.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,806.81
|
| Rate for Payer: Wellcare Medicare |
$25,895.58
|
|
|
EP INSJ PERQ VAD L HRT ARTERIAL
|
Facility
OP
|
$1,255.40
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
66574540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.92 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$690.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$494.35
|
| Rate for Payer: Aetna Government |
$494.35
|
| 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 |
$407.92
|
| Rate for Payer: Group Health Inc Commercial |
$627.70
|
| Rate for Payer: Group Health Inc Medicare |
$439.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$627.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$627.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$453.24
|
|
|
EP INSJ PERQ VAD L HRT ARTL&VEN
|
Facility
OP
|
$1,829.12
|
|
|
Service Code
|
HCPCS 33991
|
| Hospital Charge Code |
66574541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,006.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$719.78
|
| Rate for Payer: Aetna Government |
$719.78
|
| 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 |
$515.25
|
| Rate for Payer: Group Health Inc Commercial |
$914.56
|
| Rate for Payer: Group Health Inc Medicare |
$640.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$914.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$914.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$572.50
|
|
|
EP INS PM P-GEN ONLY W/SNG
|
Facility
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
66574508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$365.43 |
| Max. Negotiated Rate |
$11,572.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,824.59
|
| Rate for Payer: Aetna Government |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,824.59
|
| 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: Elderplan Medicare Advantage |
$9,824.59
|
| Rate for Payer: EmblemHealth Commercial |
$9,824.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$365.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,350.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,743.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,824.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,743.89
|
| Rate for Payer: Group Health Inc Commercial |
$9,824.59
|
| Rate for Payer: Group Health Inc Medicare |
$9,824.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,824.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$406.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,350.90
|
| Rate for Payer: Healthfirst QHP |
$9,824.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,824.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,824.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,859.67
|
| Rate for Payer: Wellcare Medicare |
$9,333.36
|
|
|
EP INS PM P-GEN ONNLY W/DUL
|
Facility
OP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
66574509
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.08 |
| Max. Negotiated Rate |
$15,525.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| Rate for Payer: Aetna Government |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,348.58
|
| 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 |
$12,348.58
|
| Rate for Payer: EmblemHealth Commercial |
$12,348.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$382.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,496.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,990.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,348.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,990.24
|
| Rate for Payer: Group Health Inc Commercial |
$12,348.58
|
| Rate for Payer: Group Health Inc Medicare |
$12,348.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,525.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$424.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,496.29
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,348.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,878.86
|
| Rate for Payer: Wellcare Medicare |
$11,731.15
|
|
|
EPIRUBICIN 200 MG/100 ML INJ
|
Facility
IP
|
$4,820.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41653777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,410.00 |
| Max. Negotiated Rate |
$2,410.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,410.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,410.00
|
|
|
EPIRUBICIN 200 MG/100 ML INJ
|
Facility
OP
|
$4,820.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41653777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$3,133.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,651.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.69
|
| Rate for Payer: Aetna Government |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,410.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,771.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$2,410.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,687.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,410.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,410.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.41
|
| Rate for Payer: SOMOS Essential |
$1.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,133.00
|
|
|
EPIRUBICIN 200 MG/100 ML INJ
|
Facility
OP
|
$4,820.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41643777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$3,133.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,651.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.69
|
| Rate for Payer: Aetna Government |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,410.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,771.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$2,410.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,687.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,410.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,410.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.41
|
| Rate for Payer: SOMOS Essential |
$1.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,133.00
|
|
|
EPIRUBICIN 200 MG/100 ML INJ
|
Facility
IP
|
$4,820.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41643777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,410.00 |
| Max. Negotiated Rate |
$2,410.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,410.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,410.00
|
|
|
EPIRUBICIN 50 MG/25 ML INJ
|
Facility
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41643776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$783.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$662.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.69
|
| Rate for Payer: Aetna Government |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$602.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$692.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$602.50
|
| Rate for Payer: Group Health Inc Medicare |
$421.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.41
|
| Rate for Payer: SOMOS Essential |
$1.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$783.25
|
|
|
EPIRUBICIN 50 MG/25 ML INJ
|
Facility
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41653776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$783.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$662.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.69
|
| Rate for Payer: Aetna Government |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$602.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$692.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$602.50
|
| Rate for Payer: Group Health Inc Medicare |
$421.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.41
|
| Rate for Payer: SOMOS Essential |
$1.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$783.25
|
|
|
EPIRUBICIN 50 MG/25 ML INJ
|
Facility
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41653776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$602.50 |
| Max. Negotiated Rate |
$602.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.50
|
|
|
EPIRUBICIN 50 MG/25 ML INJ
|
Facility
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41643776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$602.50 |
| Max. Negotiated Rate |
$602.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.50
|
|
|
EPISIOTOMY OF VAGINAL REPAIR
|
Facility
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
30107831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| 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 |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
EPISTAXIS WITH MCC
|
Facility
IP
|
$26,067.66
|
|
|
Service Code
|
MS-DRG 150
|
| Min. Negotiated Rate |
$11,271.80 |
| Max. Negotiated Rate |
$26,067.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,382.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,556.53
|
| Rate for Payer: Aetna Government |
$25,556.53
|
| Rate for Payer: Brighton Health Commercial |
$19,060.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,067.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,700.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,733.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,278.70
|
| Rate for Payer: EmblemHealth Commercial |
$11,271.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,556.53
|
| Rate for Payer: Group Health Inc Commercial |
$25,556.53
|
| Rate for Payer: Group Health Inc Medicare |
$25,556.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,556.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,883.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,556.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,556.53
|
| Rate for Payer: Wellcare Medicare |
$24,278.70
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
IP
|
$18,375.74
|
|
|
Service Code
|
MS-DRG 151
|
| Min. Negotiated Rate |
$6,608.75 |
| Max. Negotiated Rate |
$18,375.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,363.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,015.43
|
| Rate for Payer: Aetna Government |
$18,015.43
|
| Rate for Payer: Brighton Health Commercial |
$11,175.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,375.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,309.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,983.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,114.66
|
| Rate for Payer: EmblemHealth Commercial |
$6,608.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,015.43
|
| Rate for Payer: Group Health Inc Commercial |
$18,015.43
|
| Rate for Payer: Group Health Inc Medicare |
$18,015.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,015.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,377.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,015.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,015.43
|
| Rate for Payer: Wellcare Medicare |
$17,114.66
|
|
|
EPOESTIN ALFA ESRD 4,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q4105
|
| Hospital Charge Code |
41656875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.90
|
| Rate for Payer: Aetna Government |
$39.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.42
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.07
|
| Rate for Payer: SOMOS Essential |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
EPOESTIN ALFA ESRD 4,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q4105
|
| Hospital Charge Code |
41656875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 10,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 10,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41646870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 10,000 U
|
Facility
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.78
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.66
|
| Rate for Payer: Healthfirst QHP |
$0.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.80
|
| Rate for Payer: SOMOS Essential |
$0.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.63
|
| Rate for Payer: Wellcare Medicare |
$0.74
|
|
|
EPOETIN ALFA ESRD 10,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA ESRD 2,000 U
|
Facility
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5105
|
| Hospital Charge Code |
41656871
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
