|
ETOPOSIDE 20 MG/ML INJ MDV
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
41643832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
| Rate for Payer: Aetna Government |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.63
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.11
|
| Rate for Payer: SOMOS Essential |
$1.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
ETOPOSIDE 20 MG/ML INJ MDV
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
41653832
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.80
|
| Rate for Payer: Aetna Government |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.63
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.11
|
| Rate for Payer: SOMOS Essential |
$1.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
ETRAVIRINE 200MG TAB
|
Facility
OP
|
$41.77
|
|
| Hospital Charge Code |
41656613
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$33.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.88
|
| Rate for Payer: Aetna Government |
$20.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.40
|
| Rate for Payer: Group Health Inc Commercial |
$20.88
|
| Rate for Payer: Group Health Inc Medicare |
$14.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.15
|
|
|
ETRAVIRINE 200MG TAB
|
Facility
OP
|
$41.77
|
|
| Hospital Charge Code |
41646613
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$33.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.88
|
| Rate for Payer: Aetna Government |
$20.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.40
|
| Rate for Payer: Group Health Inc Commercial |
$20.88
|
| Rate for Payer: Group Health Inc Medicare |
$14.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.15
|
|
|
EV3 BALLOON DILAT NANO 2.0X150CM
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40008270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$440.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$374.00
|
| Rate for Payer: Group Health Inc Commercial |
$275.00
|
| Rate for Payer: Group Health Inc Medicare |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.00
|
|
|
EV3 NANOCROSS ELT 2.5-3MM X 210MM
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40005241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$275.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$316.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$577.50
|
| Rate for Payer: Group Health Inc Commercial |
$275.00
|
| Rate for Payer: Group Health Inc Medicare |
$192.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$357.50
|
|
|
EV3 NANOCROSS ELT 2.5-3MM X 210MM
|
Facility
IP
|
$550.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40005241
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.00 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.00
|
|
|
EV3 PERIPH PLAQUE EXC SYS
|
Facility
IP
|
$5,990.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
40008302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,995.00 |
| Max. Negotiated Rate |
$2,995.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,995.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,995.00
|
|
|
EV3 PERIPH PLAQUE EXC SYS
|
Facility
OP
|
$5,990.00
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
40008302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.91 |
| Max. Negotiated Rate |
$6,289.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,294.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$599.91
|
| Rate for Payer: Aetna Government |
$599.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,995.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,444.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,289.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,995.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,096.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,995.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,995.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,893.50
|
|
|
EVACUATED CONTAINER 1000CC
|
Facility
OP
|
$6.73
|
|
| Hospital Charge Code |
40505205
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
|
EVACUATED CONTNR-1000 ML
|
Facility
OP
|
$22.98
|
|
| Hospital Charge Code |
64901803
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.49
|
| Rate for Payer: Aetna Government |
$11.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.63
|
| Rate for Payer: Group Health Inc Commercial |
$11.49
|
| Rate for Payer: Group Health Inc Medicare |
$8.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.49
|
|
|
EVACUATED GLASS CONTAINER
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41652190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| 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 |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| 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
|
|
|
EVACUATED GLASS CONTAINER
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
41642190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| 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 |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| 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
|
|
|
EVACUATION HEMATOMA
|
Facility
OP
|
$5,632.75
|
|
|
Service Code
|
HCPCS 61312
|
| Hospital Charge Code |
40011175
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$3,098.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,098.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,640.06
|
| Rate for Payer: Aetna Government |
$2,640.06
|
| 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 |
$2,570.29
|
| Rate for Payer: Group Health Inc Commercial |
$2,816.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,971.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,816.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,816.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,855.88
|
|
|
EVAL FOR SGD - FIRST 60 MINUTES
|
Facility
OP
|
$375.15
|
|
|
Service Code
|
HCPCS 92607
|
| Hospital Charge Code |
41905002
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$18,926.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$206.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$108.92
|
| Rate for Payer: Aetna Government |
$108.92
|
| Rate for Payer: Amida Care Medicaid |
$189.26
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,926.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.72
|
| Rate for Payer: Group Health Inc Commercial |
$187.58
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.26
|
| Rate for Payer: Healthfirst Essential Plan |
$425.84
|
| Rate for Payer: Healthfirst QHP |
$189.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.26
|
| Rate for Payer: SOMOS Essential |
$425.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$189.26
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
EVAL FOR VOICE PROSTHESIS
|
Facility
OP
|
$211.43
|
|
|
Service Code
|
HCPCS 92597
|
| Hospital Charge Code |
41905005
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$18,926.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.99
|
| Rate for Payer: Aetna Government |
$61.99
|
| Rate for Payer: Amida Care Medicaid |
$189.26
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,926.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.72
|
| Rate for Payer: Group Health Inc Commercial |
$105.72
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.26
|
| Rate for Payer: Healthfirst Essential Plan |
$425.84
|
| Rate for Payer: Healthfirst QHP |
$189.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.26
|
| Rate for Payer: SOMOS Essential |
$425.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$189.26
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
EVAL IMPL PUMP WO PROGR
|
Facility
OP
|
$820.53
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
30305082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$345.41
|
| Rate for Payer: Aetna Government |
$345.41
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$345.41
|
| 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 |
$345.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$293.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$345.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$307.41
|
| 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 |
$410.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$293.60
|
| Rate for Payer: Healthfirst QHP |
$345.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$345.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$345.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$345.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$276.33
|
| Rate for Payer: Wellcare Medicare |
$328.14
|
|
|
EVAL IMPL PUMP W PROGR
|
Facility
OP
|
$820.53
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
30301655
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$345.41
|
| Rate for Payer: Aetna Government |
$345.41
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Cash Price |
$345.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$345.41
|
| 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 |
$345.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$293.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$345.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$307.41
|
| 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 |
$410.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$345.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$293.60
|
| Rate for Payer: Healthfirst QHP |
$345.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$345.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$345.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$345.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$276.33
|
| Rate for Payer: Wellcare Medicare |
$328.14
|
|
|
EVAL ORAL/PHARYNGEAL/SWALLOW
|
Facility
OP
|
$209.85
|
|
|
Service Code
|
HCPCS 92610
|
| Hospital Charge Code |
41902140
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.34
|
| Rate for Payer: Aetna Government |
$62.34
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.04
|
| Rate for Payer: Group Health Inc Commercial |
$104.92
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.04
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
EVAL SAC
|
Facility
OP
|
$6.73
|
|
| Hospital Charge Code |
40201515
|
|
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
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
30305687
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
EVALUATION OF WHEEZING
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Hospital Charge Code |
30305955
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
| Rate for Payer: Aetna Government |
$383.29
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.75
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.28
|
|
|
EVERA XT VR DEFRIB
|
Facility
OP
|
$41,450.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
66574664
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,988.80 |
| Max. Negotiated Rate |
$43,522.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,797.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,988.80
|
| Rate for Payer: Aetna Government |
$3,988.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,725.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,833.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$43,522.50
|
| Rate for Payer: Group Health Inc Commercial |
$20,725.00
|
| Rate for Payer: Group Health Inc Medicare |
$14,507.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,725.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,725.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,942.50
|
|
|
EVERC .035' OTW PTA 5 FR DIA CATH
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
40004628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
|
|
EVERC .035' OTW PTA 5 FR DIA CATH
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
40004628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.43 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.43
|
| Rate for Payer: Aetna Government |
$17.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$110.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.00
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.00
|
|
