|
ED BLADDER SONOGRAPHY
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76857 TC
|
| Hospital Charge Code |
41301135
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$186.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$49.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
ED DETAIL MOD COMPLEX VISIT FEE
|
Facility
|
IP
|
$1,885.63
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$512.19
|
|
|
ED DETAIL MOD COMPLEX VISIT FEE
|
Facility
|
OP
|
$1,885.63
|
|
|
Service Code
|
HCPCS 99284
|
| Hospital Charge Code |
30100006
|
|
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 |
$512.19
|
| Rate for Payer: Aetna Government |
$512.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$358.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$358.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$358.53
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$512.19
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$512.19
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$455.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$512.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$455.85
|
| 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 |
$512.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$512.19
|
| Rate for Payer: Humana Medicare |
$522.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$512.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$512.19
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$512.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$512.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$409.75
|
| Rate for Payer: Wellcare Medicare |
$486.58
|
|
|
ED DETAIL MODERATE COMPLEX
|
Facility
|
OP
|
$1,885.63
|
|
|
Service Code
|
HCPCS 99284 25
|
| Hospital Charge Code |
30101429
|
|
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 |
$512.19
|
| Rate for Payer: Aetna Government |
$512.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$358.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$358.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$358.53
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$512.19
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$512.19
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$455.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$512.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$455.85
|
| 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 |
$512.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$512.19
|
| Rate for Payer: Humana Medicare |
$522.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$512.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$512.19
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$512.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$512.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$409.75
|
| Rate for Payer: Wellcare Medicare |
$486.58
|
|
|
ED DETAIL MODERATE COMPLEX
|
Facility
|
IP
|
$1,885.63
|
|
|
Service Code
|
HCPCS 99284 25
|
| Hospital Charge Code |
30101429
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$512.19
|
|
|
ED DVT
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
41301133
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| 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 |
$94.00
|
| 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
|
|
|
ED DVT
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
41301133
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
ED ECHOCARDIO, TRANSTHOR, REAL
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
41301143
|
|
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
|
|
|
ED ECHOCARDIO, TRANSTHOR, REAL
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
41301143
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EDETATE CALCIUM DISODIUM 200 MG/ML INJ
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS J0600
|
| Hospital Charge Code |
41651401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$6,775.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,452.50
|
| Rate for Payer: Aetna Government |
$6,452.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,516.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,516.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,516.75
|
| Rate for Payer: Brighton Health Commercial |
$112.80
|
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,452.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$94.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,452.50
|
| Rate for Payer: EmblemHealth Commercial |
$6,452.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,452.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,452.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,775.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,452.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,775.12
|
| Rate for Payer: Group Health Inc Commercial |
$6,452.50
|
| Rate for Payer: Group Health Inc Medicare |
$6,452.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,484.62
|
| Rate for Payer: Healthfirst QHP |
$6,452.50
|
| Rate for Payer: Humana Medicare |
$6,581.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,452.50
|
| Rate for Payer: United Healthcare Commercial |
$5,708.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,452.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,162.00
|
| Rate for Payer: Wellcare Medicare |
$6,129.87
|
|
|
EDETATE CALCIUM DISODIUM 200 MG/ML INJ
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS J0600
|
| Hospital Charge Code |
41641401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.00
|
|
|
EDETATE CALCIUM DISODIUM 200 MG/ML INJ
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS J0600
|
| Hospital Charge Code |
41651401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.00
|
|
|
EDETATE CALCIUM DISODIUM 200 MG/ML INJ
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS J0600
|
| Hospital Charge Code |
41641401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$6,775.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,452.50
|
| Rate for Payer: Aetna Government |
$6,452.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,516.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,516.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,516.75
|
| Rate for Payer: Brighton Health Commercial |
$112.80
|
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Cash Price |
$6,452.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,452.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$94.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,452.50
|
| Rate for Payer: EmblemHealth Commercial |
$6,452.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,452.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,452.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,775.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,452.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,775.12
|
| Rate for Payer: Group Health Inc Commercial |
$6,452.50
|
| Rate for Payer: Group Health Inc Medicare |
$6,452.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$94.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,484.62
|
| Rate for Payer: Healthfirst QHP |
$6,452.50
|
| Rate for Payer: Humana Medicare |
$6,581.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,452.50
|
| Rate for Payer: United Healthcare Commercial |
$5,708.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,452.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,162.00
|
| Rate for Payer: Wellcare Medicare |
$6,129.87
|
|
|
ED HIGH COMPLEX
|
Facility
|
OP
|
$3,480.31
|
|
|
Service Code
|
HCPCS 99285 25
|
| Hospital Charge Code |
30101431
|
|
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 |
$742.78
|
| Rate for Payer: Aetna Government |
$742.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$519.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$519.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$519.95
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$742.78
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$742.78
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$631.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$661.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$661.07
|
| 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 |
$742.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$742.78
|
| Rate for Payer: Humana Medicare |
$757.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$742.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.78
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$742.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$594.22
|
| Rate for Payer: Wellcare Medicare |
$705.64
|
|
|
ED HIGH COMPLEX
|
Facility
|
IP
|
$3,480.31
|
|
|
Service Code
|
HCPCS 99285 25
|
| Hospital Charge Code |
30101431
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$742.78
|
|
|
ED HIGH COMPLEXITY VISIT FEE
|
Facility
|
IP
|
$3,480.31
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
30100007
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$742.78
|
|
|
ED HIGH COMPLEXITY VISIT FEE
|
Facility
|
OP
|
$3,480.31
|
|
|
Service Code
|
HCPCS 99285
|
| Hospital Charge Code |
30100007
|
|
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 |
$742.78
|
| Rate for Payer: Aetna Government |
$742.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$519.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$519.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$519.95
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$742.78
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$742.78
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$631.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$661.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$661.07
|
| 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 |
$742.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$742.78
|
| Rate for Payer: Humana Medicare |
$757.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$742.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.78
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$742.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$594.22
|
| Rate for Payer: Wellcare Medicare |
$705.64
|
|
|
ED LOW COMPLEXITY
|
Facility
|
IP
|
$979.88
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
30100003
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$189.13
|
|
|
ED LOW COMPLEXITY
|
Facility
|
OP
|
$979.88
|
|
|
Service Code
|
HCPCS 99282
|
| Hospital Charge Code |
30100003
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.39 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.13
|
| Rate for Payer: Aetna Government |
$189.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$132.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$132.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$132.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$189.13
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$189.13
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.33
|
| 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 |
$189.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$189.13
|
| Rate for Payer: Humana Medicare |
$192.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.13
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$151.30
|
| Rate for Payer: Wellcare Medicare |
$179.67
|
|
|
ED LOW COMPLEXITY -
|
Facility
|
OP
|
$979.88
|
|
|
Service Code
|
HCPCS 99282 25
|
| Hospital Charge Code |
30101427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.39 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.13
|
| Rate for Payer: Aetna Government |
$189.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$132.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$132.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$132.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$189.13
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$189.13
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.33
|
| 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 |
$189.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$189.13
|
| Rate for Payer: Humana Medicare |
$192.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.13
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$151.30
|
| Rate for Payer: Wellcare Medicare |
$179.67
|
|
|
ED LOW COMPLEXITY -
|
Facility
|
IP
|
$979.88
|
|
|
Service Code
|
HCPCS 99282 25
|
| Hospital Charge Code |
30101427
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$189.13
|
|
|
ED LOW COMPLXITY
|
Facility
|
OP
|
$340.04
|
|
|
Service Code
|
HCPCS 99282 95
|
| Hospital Charge Code |
30100349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.39 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.13
|
| Rate for Payer: Aetna Government |
$189.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$132.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$132.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$132.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$189.13
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$189.13
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.33
|
| 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 |
$170.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$189.13
|
| Rate for Payer: Humana Medicare |
$192.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.13
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$151.30
|
| Rate for Payer: Wellcare Medicare |
$179.67
|
|
|
ED LOW COMPLXITY
|
Facility
|
IP
|
$340.04
|
|
|
Service Code
|
HCPCS 99282 95
|
| Hospital Charge Code |
30100349
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$189.13
|
|
|
ED MODERATE COMPLEX
|
Facility
|
IP
|
$1,246.36
|
|
|
Service Code
|
HCPCS 99283 25
|
| Hospital Charge Code |
30101428
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$329.95
|
|
|
ED MODERATE COMPLEX
|
Facility
|
OP
|
$1,246.36
|
|
|
Service Code
|
HCPCS 99283 25
|
| Hospital Charge Code |
30101428
|
|
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 |
$329.95
|
| Rate for Payer: Aetna Government |
$329.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$230.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$230.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$230.96
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$329.95
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$329.95
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$293.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$293.66
|
| 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 |
$329.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$329.95
|
| Rate for Payer: Humana Medicare |
$336.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$329.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$329.95
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$329.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$329.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$263.96
|
| Rate for Payer: Wellcare Medicare |
$313.45
|
|
