|
ECHOTHIOPHATE IODIDE 0.125% OPHTHALMIC S
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
41641087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.50
|
| Rate for Payer: Aetna Government |
$67.50
|
| Rate for Payer: Brighton Health Commercial |
$101.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.80
|
| Rate for Payer: Group Health Inc Commercial |
$67.50
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.75
|
|
|
ECHO TRANSESOPHEGEAL (TEE)
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93318 TC
|
| Hospital Charge Code |
30303079
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
ECHO TRANSESOPHEGEAL (TEE)
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93318 TC
|
| Hospital Charge Code |
30303079
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$446.58 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$1,093.94
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$637.97
|
| Rate for Payer: Group Health Inc Medicare |
$637.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
ECHO TRANSTHORACIC
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93304 TC
|
| Hospital Charge Code |
30101212
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$1,093.94
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$637.97
|
| Rate for Payer: Group Health Inc Medicare |
$637.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
ECHO TRANSTHORACIC
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93304 TC
|
| Hospital Charge Code |
30101212
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
ECHOVIRUS AB (4,9,11,16)
|
Facility
|
OP
|
$32.58
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
40728113
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.60
|
| Rate for Payer: Group Health Inc Commercial |
$13.03
|
| Rate for Payer: Group Health Inc Medicare |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.03
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: Humana Medicare |
$13.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.42
|
| Rate for Payer: Wellcare Medicare |
$11.73
|
|
|
ECHOVIRUS AB (4,9,11,16)
|
Facility
|
IP
|
$32.58
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
40728113
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$13.03
|
|
|
ECHO W DOPPLER- F/U OR LIMITED ST
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
40804107
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
ECHO W DOPPLER- F/U OR LIMITED ST
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
40804107
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
ECHO WITH BUBBLE SETTING
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
40804115
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
ECHO WITH BUBBLE SETTING
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
40804115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$446.58 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$1,093.94
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$637.97
|
| Rate for Payer: Group Health Inc Medicare |
$637.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
ECHO WITH COLOR DOPPLER
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
40804106
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
ECHO WITH COLOR DOPPLER
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
40804106
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$446.58 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$1,093.94
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$637.97
|
| Rate for Payer: Group Health Inc Medicare |
$637.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$423,996.81
|
|
|
Service Code
|
MSDRG 003
|
| Min. Negotiated Rate |
$140,887.86 |
| Max. Negotiated Rate |
$423,996.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$314,367.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$302,984.65
|
| Rate for Payer: Aetna Government |
$302,984.65
|
| Rate for Payer: Brighton Health Commercial |
$309,144.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$309,044.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$368,180.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$303,838.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$287,835.42
|
| Rate for Payer: EmblemHealth Commercial |
$182,822.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$302,984.65
|
| Rate for Payer: Group Health Inc Commercial |
$302,984.65
|
| Rate for Payer: Group Health Inc Medicare |
$302,984.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302,984.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140,887.86
|
| Rate for Payer: Humana Medicare |
$416,603.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$302,984.65
|
| Rate for Payer: United Healthcare Commercial |
$423,996.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302,984.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302,984.65
|
| Rate for Payer: Wellcare Medicare |
$287,835.42
|
|
|
ECONAZOLE 1% CREAM 15 GRAMS
|
Facility
|
OP
|
$5.94
|
|
| Hospital Charge Code |
41644602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna Government |
$2.97
|
| Rate for Payer: Brighton Health Commercial |
$4.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.04
|
| Rate for Payer: Group Health Inc Commercial |
$2.97
|
| Rate for Payer: Group Health Inc Medicare |
$2.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.86
|
|
|
ECONAZOLE 1% CREAM 15 GRAMS
|
Facility
|
OP
|
$5.94
|
|
| Hospital Charge Code |
41654602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna Government |
$2.97
|
| Rate for Payer: Brighton Health Commercial |
$4.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.04
|
| Rate for Payer: Group Health Inc Commercial |
$2.97
|
| Rate for Payer: Group Health Inc Medicare |
$2.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.86
|
|
|
ECULIZUMAB 300MG/30ML INJ - NF
|
Facility
|
OP
|
$509.25
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
41656619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$331.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$280.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.68
|
| Rate for Payer: Aetna Government |
$225.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$157.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$157.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$157.98
|
| Rate for Payer: Brighton Health Commercial |
$305.55
|
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$254.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$292.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$225.68
|
| Rate for Payer: EmblemHealth Commercial |
$225.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$236.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$236.97
|
| Rate for Payer: Group Health Inc Commercial |
$225.68
|
| Rate for Payer: Group Health Inc Medicare |
$225.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.83
|
| Rate for Payer: Healthfirst QHP |
$225.68
|
| Rate for Payer: Humana Medicare |
$230.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.25
|
| Rate for Payer: SOMOS Essential |
$239.25
|
| Rate for Payer: United Healthcare Commercial |
$227.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$180.55
|
| Rate for Payer: Wellcare Medicare |
$214.40
|
|
|
ECULIZUMAB 300MG/30ML INJ - NF
|
Facility
|
IP
|
$509.25
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
41656619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$254.62 |
| Max. Negotiated Rate |
$254.62 |
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.62
|
|
|
ECULIZUMAB 300MG/30ML INJ - NF
|
Facility
|
OP
|
$509.25
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
41646619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$331.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$280.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.68
|
| Rate for Payer: Aetna Government |
$225.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$157.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$157.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$157.98
|
| Rate for Payer: Brighton Health Commercial |
$305.55
|
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$254.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$292.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$225.68
|
| Rate for Payer: EmblemHealth Commercial |
$225.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$236.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$236.97
|
| Rate for Payer: Group Health Inc Commercial |
$225.68
|
| Rate for Payer: Group Health Inc Medicare |
$225.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.83
|
| Rate for Payer: Healthfirst QHP |
$225.68
|
| Rate for Payer: Humana Medicare |
$230.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.25
|
| Rate for Payer: SOMOS Essential |
$239.25
|
| Rate for Payer: United Healthcare Commercial |
$227.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$331.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$180.55
|
| Rate for Payer: Wellcare Medicare |
$214.40
|
|
|
ECULIZUMAB 300MG/30ML INJ - NF
|
Facility
|
IP
|
$509.25
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
41646619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$254.62 |
| Max. Negotiated Rate |
$254.62 |
| Rate for Payer: Cash Price |
$225.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$254.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$254.62
|
|
|
ECULIZUMAB 300 MG/30ML IV SOLN [81696]
|
Facility
|
OP
|
$260.92
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
25682000101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$230.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.68
|
| Rate for Payer: Aetna Government |
$225.68
|
| Rate for Payer: Brighton Health Commercial |
$156.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$150.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$225.68
|
| Rate for Payer: EmblemHealth Commercial |
$130.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.68
|
| Rate for Payer: Group Health Inc Commercial |
$225.68
|
| Rate for Payer: Group Health Inc Medicare |
$225.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$191.83
|
| Rate for Payer: Healthfirst QHP |
$225.68
|
| Rate for Payer: Humana Medicare |
$230.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$180.55
|
|
|
ECULIZUMAB 300 MG/30ML IV SOLN [81696]
|
Facility
|
IP
|
$260.92
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
25682000101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$130.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.46
|
|
|
ECXISION OF NECK CYST CONF TO SKI
|
Facility
|
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 42810
|
| Hospital Charge Code |
40109227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,949.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,606.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,606.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,606.26
|
| Rate for Payer: Brighton Health Commercial |
$5,949.88
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Humana Medicare |
$3,797.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
ECXISION OF NECK CYST CONF TO SKI
|
Facility
|
IP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 42810
|
| Hospital Charge Code |
40109227
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,723.23
|
|
|
ED BLADDER SONOGRAPHY
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76857 TC
|
| Hospital Charge Code |
41301135
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
