|
EQ UROGRAPHY RTRGR +-KUB
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 74420 TC
|
| Hospital Charge Code |
41107484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$925.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.26
|
| Rate for Payer: Aetna Government |
$578.26
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$925.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.10
|
| Rate for Payer: Group Health Inc Commercial |
$578.26
|
| Rate for Payer: Group Health Inc Medicare |
$404.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.67
|
|
|
EQ UROGRPHY ANTEGRADE RS&I
|
Facility
OP
|
$1,141.00
|
|
|
Service Code
|
HCPCS 74425 TC
|
| Hospital Charge Code |
41102725
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$912.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$627.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$570.50
|
| Rate for Payer: Aetna Government |
$570.50
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$912.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$775.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.38
|
| Rate for Payer: Group Health Inc Commercial |
$570.50
|
| Rate for Payer: Group Health Inc Medicare |
$399.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$570.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$570.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.42
|
|
|
EQ VENOUS SAMPLING
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75893 TC
|
| Hospital Charge Code |
41102701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.27 |
| Max. Negotiated Rate |
$11,136.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,656.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,960.35
|
| Rate for Payer: Aetna Government |
$6,960.35
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,136.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,466.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,960.35
|
| Rate for Payer: Group Health Inc Medicare |
$4,872.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,960.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.08
|
|
|
EQ VISCERAL W/WO FLUSH
|
Facility
OP
|
$13,920.70
|
|
|
Service Code
|
HCPCS 75726 TC
|
| Hospital Charge Code |
41102576
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$11,136.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,656.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,960.35
|
| Rate for Payer: Aetna Government |
$6,960.35
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cash Price |
$6,354.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,136.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,466.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.80
|
| Rate for Payer: Group Health Inc Commercial |
$6,960.35
|
| Rate for Payer: Group Health Inc Medicare |
$4,872.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,960.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.44
|
|
|
EQ WHITAKER TEST
|
Facility
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37700 TC
|
| Hospital Charge Code |
41107483
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$4,616.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,196.76
|
| Rate for Payer: Aetna Government |
$4,196.76
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.76
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.76
|
|
|
EQ WRIST ARTHOGRAM
|
Facility
OP
|
$1,156.53
|
|
|
Service Code
|
HCPCS 73115 TC
|
| Hospital Charge Code |
41102468
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$925.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$636.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.26
|
| Rate for Payer: Aetna Government |
$578.26
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cash Price |
$444.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$925.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$786.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.20
|
| Rate for Payer: Group Health Inc Commercial |
$578.26
|
| Rate for Payer: Group Health Inc Medicare |
$404.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.67
|
|
|
ERAVACYCLINE 50MG/5ML INJ
|
Facility
OP
|
$2.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41653891
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.10
|
| Rate for Payer: Aetna Government |
$1.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.26
|
| Rate for Payer: Group Health Inc Commercial |
$1.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.43
|
|
|
ERAVACYCLINE 50MG/5ML INJ
|
Facility
IP
|
$2.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41643891
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
ERAVACYCLINE 50MG/5ML INJ
|
Facility
IP
|
$2.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41653891
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
|
|
ERAVACYCLINE 50MG/5ML INJ
|
Facility
OP
|
$2.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41643891
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.10
|
| Rate for Payer: Aetna Government |
$1.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.26
|
| Rate for Payer: Group Health Inc Commercial |
$1.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.43
|
|
|
ERBULIN 1MG/2ML INJ
|
Facility
OP
|
$258.50
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
41646650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.95 |
| Max. Negotiated Rate |
$10,295.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.02
|
| Rate for Payer: Aetna Government |
$134.02
|
| Rate for Payer: Amida Care Medicaid |
$102.95
|
| Rate for Payer: Cash Price |
$134.02
|
| Rate for Payer: Cash Price |
$134.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$129.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$148.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$134.02
|
| Rate for Payer: EmblemHealth Commercial |
$134.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10,295.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.10
|
| Rate for Payer: Group Health Inc Commercial |
$134.02
|
| Rate for Payer: Group Health Inc Medicare |
$134.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.95
|
| Rate for Payer: Healthfirst Essential Plan |
$102.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.91
|
| Rate for Payer: Healthfirst QHP |
$102.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.95
|
| Rate for Payer: SOMOS Essential |
$102.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$107.21
|
| Rate for Payer: Wellcare Medicare |
$127.32
|
|
|
ERBULIN 1MG/2ML INJ
|
Facility
IP
|
$258.50
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
41646650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$129.25 |
| Rate for Payer: Cash Price |
$134.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.25
|
|
|
ERCP DIAGNOSTIC
|
Facility
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
41118921
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.12 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$343.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ERCP DIAGNOSTIC
|
Facility
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
40014287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.12 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$343.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ERCP WITH BIOPSY
|
Facility
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
40014288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$401.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ERCP WITH BIOPSY
|
Facility
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
41118922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$401.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ER EM CRITICAL CARE
|
Facility
OP
|
$2,019.15
|
|
|
Service Code
|
HCPCS 99291 27
|
| Hospital Charge Code |
30106639
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,009.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,009.58
|
| Rate for Payer: Aetna Government |
$1,009.58
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,009.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,009.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ER EM DETAILED
|
Facility
OP
|
$1,885.63
|
|
|
Service Code
|
HCPCS 99284 27
|
| Hospital Charge Code |
30106643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$942.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$942.82
|
| Rate for Payer: Aetna Government |
$942.82
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$942.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$942.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ER EM EXPANDED
|
Facility
OP
|
$1,246.36
|
|
|
Service Code
|
HCPCS 99283 27
|
| Hospital Charge Code |
30106645
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$623.18
|
| Rate for Payer: Aetna Government |
$623.18
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$623.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$623.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ER EM HIGH COMPLEX
|
Facility
OP
|
$3,480.31
|
|
|
Service Code
|
HCPCS 99285 27
|
| Hospital Charge Code |
30106644
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,740.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,740.16
|
| Rate for Payer: Aetna Government |
$1,740.16
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,740.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,740.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ER EM LOW COMPLEX
|
Facility
OP
|
$979.88
|
|
|
Service Code
|
HCPCS 99282 27
|
| Hospital Charge Code |
30106641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$489.94
|
| Rate for Payer: Aetna Government |
$489.94
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$489.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ER EM STRAIGHTFORWARD
|
Facility
OP
|
$712.75
|
|
|
Service Code
|
HCPCS 99281 27
|
| Hospital Charge Code |
30106640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$356.38
|
| Rate for Payer: Aetna Government |
$356.38
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$356.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
ERGOCALCIFEROL 50,000 INTL UNITS CAP
|
Facility
OP
|
$2.24
|
|
| Hospital Charge Code |
41651225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.12
|
| Rate for Payer: Aetna Government |
$1.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.46
|
|
|
ERGOCALCIFEROL 50,000 INTL UNITS CAP
|
Facility
OP
|
$2.24
|
|
| Hospital Charge Code |
41641225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.12
|
| Rate for Payer: Aetna Government |
$1.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.46
|
|
|
ERGOCALCIFEROL 8,000 INTL UNITS/ML LIQUI
|
Facility
OP
|
$122.00
|
|
| Hospital Charge Code |
41640945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$97.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.00
|
| Rate for Payer: Aetna Government |
$61.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.96
|
| Rate for Payer: Group Health Inc Commercial |
$61.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.30
|
|
