|
ESOMEPRAZOLE 40MG IV PED - 5MG
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41657083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.75
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
ESOMEPRAZOLE 40MG IV PED - 5MG
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41647083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.75
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
ESOMEPRAZOLE 40MG IV PED - 5MG
|
Facility
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41647083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
ESOMEPRAZOLE 40MG IV PED - 5MG
|
Facility
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41657083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
ESOMEPRAZOLE SACHET GRANULES 10 MG
|
Facility
OP
|
$4.95
|
|
| Hospital Charge Code |
41655152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.37
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.22
|
|
|
ESOMEPRAZOLE SACHET GRANULES 10 MG
|
Facility
OP
|
$4.95
|
|
| Hospital Charge Code |
41645152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.37
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.22
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
IP
|
$25,518.82
|
|
|
Service Code
|
MS-DRG 391
|
| Min. Negotiated Rate |
$10,939.10 |
| Max. Negotiated Rate |
$25,518.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,810.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,018.45
|
| Rate for Payer: Aetna Government |
$25,018.45
|
| Rate for Payer: Brighton Health Commercial |
$18,497.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,518.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,030.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,180.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,767.53
|
| Rate for Payer: EmblemHealth Commercial |
$10,939.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,018.45
|
| Rate for Payer: Group Health Inc Commercial |
$25,018.45
|
| Rate for Payer: Group Health Inc Medicare |
$25,018.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,018.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,633.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,018.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,018.45
|
| Rate for Payer: Wellcare Medicare |
$23,767.53
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
IP
|
$18,586.50
|
|
|
Service Code
|
MS-DRG 392
|
| Min. Negotiated Rate |
$6,736.52 |
| Max. Negotiated Rate |
$18,586.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,583.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,222.06
|
| Rate for Payer: Aetna Government |
$18,222.06
|
| Rate for Payer: Brighton Health Commercial |
$11,391.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,586.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,566.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,195.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,310.96
|
| Rate for Payer: EmblemHealth Commercial |
$6,736.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,222.06
|
| Rate for Payer: Group Health Inc Commercial |
$18,222.06
|
| Rate for Payer: Group Health Inc Medicare |
$18,222.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,222.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,473.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,222.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,222.06
|
| Rate for Payer: Wellcare Medicare |
$17,310.96
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$261.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$261.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.02 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
ESOPHAGOSCOPY
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
40108840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.33 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ESOPHAGOSCOPY ULTRASOUND EXAM
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43231
|
| Hospital Charge Code |
41112827
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$167.84 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$186.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
ESOPHAGOSCOPY W/US NEEDLE BX
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43232
|
| Hospital Charge Code |
41112828
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$209.64 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
ESOPHAGUS ENDOSCOPY
|
Facility
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 43200
|
| Hospital Charge Code |
40014091
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.33 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
ESOPHAGUS ENDOSCOPY W/BIOPSY
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43202
|
| Hospital Charge Code |
40014092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$111.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
ESOPHAGUS MOTILITY STUDY
|
Facility
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 91010 TC
|
| Hospital Charge Code |
41118900
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$175.88 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$735.40
|
| Rate for Payer: Aetna Government |
$735.40
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.88
|
| Rate for Payer: Group Health Inc Commercial |
$735.40
|
| Rate for Payer: Group Health Inc Medicare |
$514.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.42
|
|
|
ESOPH ENDOSCOPY DILATION
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43220
|
| Hospital Charge Code |
41118910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
ESOPHGSCPY,REMOVL FORGN BODY
|
Facility
OP
|
$4,716.98
|
|
|
Service Code
|
HCPCS 43215
|
| Hospital Charge Code |
40108830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$154.15 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Cash Price |
$2,200.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
ESTABLISHED PT PRE AGE 12-17
|
Facility
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 99394
|
| Hospital Charge Code |
30301242
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.44 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$71.44
|
| Rate for Payer: Aetna Government |
$71.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
|
|
ESTABLISHED PT PRE AGE 18-39
|
Facility
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
30301243
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.27
|
| Rate for Payer: Aetna Government |
$66.27
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
|
|
ESTABLISHED PT PRE AGE 40-64
|
Facility
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 99396
|
| Hospital Charge Code |
30301244
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.08
|
| Rate for Payer: Aetna Government |
$72.08
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
|
|
ESTABLISHED PT PRE AGE 65-OVER
|
Facility
OP
|
$358.63
|
|
|
Service Code
|
HCPCS 99397
|
| Hospital Charge Code |
30301245
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.81 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.81
|
| Rate for Payer: Aetna Government |
$75.81
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
|
