|
ELVITEG-COBIC-EMTRICIT-TENOFDF 150-150-200-300 MG PO TABS [117293]
|
Facility
|
OP
|
$167.05
|
|
|
Service Code
|
NDC 61958120101
|
| Hospital Charge Code |
61958120101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.47 |
| Max. Negotiated Rate |
$133.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.53
|
| Rate for Payer: Aetna Government |
$83.53
|
| Rate for Payer: Brighton Health Commercial |
$125.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.60
|
| Rate for Payer: Group Health Inc Commercial |
$83.53
|
| Rate for Payer: Group Health Inc Medicare |
$58.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.58
|
|
|
EM ABLATION, THEMAL, W/O
|
Facility
|
OP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
30301266
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$6,468.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,751.94
|
| Rate for Payer: Aetna Government |
$5,751.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,026.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,026.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,026.36
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Cash Price |
$5,751.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,751.94
|
| 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 |
$5,751.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,889.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,119.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,751.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,119.23
|
| 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 |
$6,468.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,751.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,889.15
|
| Rate for Payer: Healthfirst QHP |
$5,751.94
|
| Rate for Payer: Humana Medicare |
$5,866.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,751.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,751.94
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,751.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,751.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,601.55
|
| Rate for Payer: Wellcare Medicare |
$5,464.34
|
|
|
EM ABLATION, THEMAL, W/O
|
Facility
|
IP
|
$12,937.43
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
30301266
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$5,751.94
|
|
|
EMBOZENE MICROSH 900 2ML
|
Facility
|
OP
|
$412.50
|
|
| Hospital Charge Code |
64903551
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$206.25
|
| Rate for Payer: Aetna Government |
$206.25
|
| Rate for Payer: Brighton Health Commercial |
$309.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
| Rate for Payer: Group Health Inc Commercial |
$206.25
|
| Rate for Payer: Group Health Inc Medicare |
$144.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
|
|
EMBOZENE MICROSP 500 UM 2ML
|
Facility
|
OP
|
$412.50
|
|
| Hospital Charge Code |
64903558
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$206.25
|
| Rate for Payer: Aetna Government |
$206.25
|
| Rate for Payer: Brighton Health Commercial |
$309.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
| Rate for Payer: Group Health Inc Commercial |
$206.25
|
| Rate for Payer: Group Health Inc Medicare |
$144.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
|
|
EMBOZENE MICROSPH 700 UM 2ML
|
Facility
|
OP
|
$412.50
|
|
| Hospital Charge Code |
64903556
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$144.38 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$226.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$206.25
|
| Rate for Payer: Aetna Government |
$206.25
|
| Rate for Payer: Brighton Health Commercial |
$309.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$330.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$280.50
|
| Rate for Payer: Group Health Inc Commercial |
$206.25
|
| Rate for Payer: Group Health Inc Medicare |
$144.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.25
|
|
|
EMENTECTOMY
|
Facility
|
IP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 41820
|
| Hospital Charge Code |
40011275
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,723.23
|
|
|
EMENTECTOMY
|
Facility
|
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 41820
|
| Hospital Charge Code |
40011275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$5,949.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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
|
|
|
EMERGENCY INTUBATION ENDOTRACHEAL
|
Facility
|
OP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
30300035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$197.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$197.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$197.73
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$311.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Humana Medicare |
$288.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
EMERGENCY INTUBATION ENDOTRACHEAL
|
Facility
|
IP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
30103035
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
EMERGENCY INTUBATION ENDOTRACHEAL
|
Facility
|
OP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
40000352
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$197.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$197.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$197.73
|
| Rate for Payer: Brighton Health Commercial |
$467.78
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| Rate for Payer: Group Health Inc Commercial |
$282.47
|
| Rate for Payer: Group Health Inc Medicare |
$282.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Humana Medicare |
$288.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
EMERGENCY INTUBATION ENDOTRACHEAL
|
Facility
|
OP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
30103035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$197.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$197.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$197.73
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$311.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Humana Medicare |
$288.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
EMERGENCY INTUBATION ENDOTRACHEAL
|
Facility
|
IP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
40000352
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
EMERGENCY INTUBATION ENDOTRACHEAL
|
Facility
|
IP
|
$623.70
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
30300035
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
EMERGENCY SERVICE FEE
|
Facility
|
IP
|
$712.75
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
30100002
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$102.67
|
|
|
EMERGENCY SERVICE FEE
|
Facility
|
OP
|
$712.75
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
30100002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.67
|
| Rate for Payer: Aetna Government |
$102.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$71.87
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$102.67
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$102.67
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.38
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$102.67
|
| Rate for Payer: Humana Medicare |
$104.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.67
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.14
|
| Rate for Payer: Wellcare Medicare |
$97.54
|
|
|
EMERGENCY TRACHEOSTOMY
|
Facility
|
IP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
40013185
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,763.60
|
|
|
EMERGENCY TRACHEOSTOMY
|
Facility
|
OP
|
$4,086.83
|
|
|
Service Code
|
HCPCS 31603
|
| Hospital Charge Code |
40013185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.52 |
| Max. Negotiated Rate |
$3,065.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,234.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,234.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,234.52
|
| Rate for Payer: Brighton Health Commercial |
$3,065.12
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| 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 |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Humana Medicare |
$1,798.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
EMERGENCY TRACHEOTOMY
|
Facility
|
OP
|
$1,812.50
|
|
|
Service Code
|
HCPCS D7990
|
| Hospital Charge Code |
42302155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.59 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$996.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$451.59
|
| Rate for Payer: Aetna Government |
$451.59
|
| Rate for Payer: Brighton Health Commercial |
$1,359.38
|
| 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: Group Health Inc Commercial |
$906.25
|
| Rate for Payer: Group Health Inc Medicare |
$634.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$906.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$906.25
|
|
|
EMERSON PUMP UNDWTR DRAIN MAC
|
Facility
|
OP
|
$49.61
|
|
| Hospital Charge Code |
40200820
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$39.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.80
|
| Rate for Payer: Aetna Government |
$24.80
|
| Rate for Payer: Brighton Health Commercial |
$37.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.73
|
| Rate for Payer: Group Health Inc Commercial |
$24.80
|
| Rate for Payer: Group Health Inc Medicare |
$17.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.80
|
|
|
EMESIS BASIN
|
Facility
|
OP
|
$6.73
|
|
| Hospital Charge Code |
40201480
|
|
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: Brighton Health Commercial |
$5.05
|
| 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
|
|
|
EMG ANAL/URETHR SPHINCT NOT NEEDL
|
Facility
|
OP
|
$406.05
|
|
|
Service Code
|
HCPCS 51784 TC
|
| Hospital Charge Code |
30302041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| 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 |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| 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 |
$203.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
EMG ANAL/URETHR SPHINCT NOT NEEDL
|
Facility
|
IP
|
$406.05
|
|
|
Service Code
|
HCPCS 51784 TC
|
| Hospital Charge Code |
30302041
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
EMG-SP MUSCLE
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95869 TC
|
| Hospital Charge Code |
30301996
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$370.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
EMG-SP MUSCLE
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 95869 TC
|
| Hospital Charge Code |
30301996
|
|
Hospital Revenue Code
|
922
|
| Rate for Payer: Cash Price |
$362.98
|
|
