|
ENTRY REAMER SOLID SHAFT
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$480.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$480.00
|
|
|
ENTRY REAMER SOLID SHAFT
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$528.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$576.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$552.00
|
| Rate for Payer: EmblemHealth Commercial |
$480.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,008.00
|
| Rate for Payer: Group Health Inc Commercial |
$480.00
|
| Rate for Payer: Group Health Inc Medicare |
$336.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$480.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$480.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$624.00
|
|
|
ENUCLEATION - EYE
|
Facility
|
OP
|
$9,471.08
|
|
|
Service Code
|
HCPCS 65101
|
| Hospital Charge Code |
40072490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,103.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,471.17
|
| Rate for Payer: Aetna Government |
$4,471.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,129.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,129.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,129.82
|
| Rate for Payer: Brighton Health Commercial |
$7,103.31
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,471.17
|
| 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 |
$4,471.17
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,800.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,979.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,471.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,979.34
|
| Rate for Payer: Group Health Inc Commercial |
$4,471.17
|
| Rate for Payer: Group Health Inc Medicare |
$4,471.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,735.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,471.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,800.49
|
| Rate for Payer: Healthfirst QHP |
$4,471.17
|
| Rate for Payer: Humana Medicare |
$4,560.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,471.17
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,471.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,471.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,576.94
|
| Rate for Payer: Wellcare Medicare |
$4,247.61
|
|
|
ENUCLEATION - EYE
|
Facility
|
IP
|
$9,471.08
|
|
|
Service Code
|
HCPCS 65101
|
| Hospital Charge Code |
40072490
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,471.17
|
|
|
ENUCLEATION OF EYE WITH IMPLANT
|
Facility
|
OP
|
$9,471.08
|
|
|
Service Code
|
HCPCS 65103
|
| Hospital Charge Code |
40073212
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$7,103.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,471.17
|
| Rate for Payer: Aetna Government |
$4,471.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,129.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,129.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,129.82
|
| Rate for Payer: Brighton Health Commercial |
$7,103.31
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Cash Price |
$4,471.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,471.17
|
| 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 |
$4,471.17
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,800.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,979.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,471.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,979.34
|
| Rate for Payer: Group Health Inc Commercial |
$4,471.17
|
| Rate for Payer: Group Health Inc Medicare |
$4,471.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,735.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,471.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,800.49
|
| Rate for Payer: Healthfirst QHP |
$4,471.17
|
| Rate for Payer: Humana Medicare |
$4,560.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,471.17
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,471.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,471.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,576.94
|
| Rate for Payer: Wellcare Medicare |
$4,247.61
|
|
|
ENUCLEATION OF EYE WITH IMPLANT
|
Facility
|
IP
|
$9,471.08
|
|
|
Service Code
|
HCPCS 65103
|
| Hospital Charge Code |
40073212
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,471.17
|
|
|
ENVELOPE STEAM STERILIZATION
|
Facility
|
OP
|
$0.71
|
|
| Hospital Charge Code |
64901514
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
|
|
ENVIROMENTAL MANAGEMENT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 90882
|
| Hospital Charge Code |
30400098
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$2,030.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.44
|
| Rate for Payer: Aetna Government |
$70.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.30
|
| Rate for Payer: Amida Care Medicaid |
$20.30
|
| Rate for Payer: Brighton Health Commercial |
$150.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,030.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.32
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.30
|
| Rate for Payer: Healthfirst Essential Plan |
$45.68
|
| Rate for Payer: Healthfirst QHP |
$20.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.30
|
| Rate for Payer: SOMOS Essential |
$45.68
|
| Rate for Payer: United Healthcare Commercial |
$100.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.33
|
| Rate for Payer: United Healthcare Medicaid |
$20.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.30
|
|
|
EOPETIN ALFA NON-ESRD 40,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$8.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.82
|
| Rate for Payer: Aetna Government |
$7.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.51
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.82
|
| Rate for Payer: EmblemHealth Commercial |
$7.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$7.82
|
| Rate for Payer: Group Health Inc Medicare |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.65
|
| Rate for Payer: Healthfirst QHP |
$7.82
|
| Rate for Payer: Humana Medicare |
$7.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.96
|
| Rate for Payer: SOMOS Essential |
$7.96
|
| Rate for Payer: United Healthcare Commercial |
$8.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.26
|
| Rate for Payer: Wellcare Medicare |
$7.43
|
|
|
EOPETIN ALFA NON-ESRD 40,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
41656867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Cash Price |
$7.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EOSINOPHIL COUNT SPUTUM
|
Facility
|
OP
|
$162.75
|
|
|
Service Code
|
HCPCS 85999
|
| Hospital Charge Code |
40623147
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$122.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.38
|
| Rate for Payer: Aetna Government |
$81.38
|
| Rate for Payer: Brighton Health Commercial |
$122.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.31
|
| Rate for Payer: Group Health Inc Commercial |
$81.38
|
| Rate for Payer: Group Health Inc Medicare |
$56.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.38
|
|
|
EP AAI IMPLANT
|
Facility
|
OP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33206
|
| Hospital Charge Code |
66574503
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$23,287.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| Rate for Payer: Aetna Government |
$12,348.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,644.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,644.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,644.01
|
| Rate for Payer: Brighton Health Commercial |
$23,287.94
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,348.58
|
| 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 |
$12,348.58
|
| Rate for Payer: EmblemHealth Commercial |
$12,348.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,496.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,990.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,348.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,990.24
|
| Rate for Payer: Group Health Inc Commercial |
$12,348.58
|
| Rate for Payer: Group Health Inc Medicare |
$12,348.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,525.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,496.29
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Humana Medicare |
$12,595.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,348.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,348.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,878.86
|
| Rate for Payer: Wellcare Medicare |
$11,731.15
|
|
|
EP AAI IMPLANT
|
Facility
|
IP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33206
|
| Hospital Charge Code |
66574503
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
EP ART LINE PLACEMENT
|
Facility
|
OP
|
$174.04
|
|
|
Service Code
|
HCPCS 36620
|
| Hospital Charge Code |
66574546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.54
|
| Rate for Payer: Aetna Government |
$53.54
|
| Rate for Payer: Brighton Health Commercial |
$130.53
|
| 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 |
$87.02
|
| Rate for Payer: Group Health Inc Medicare |
$60.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.02
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
EP DBRIDMNT SKN/SUB TISSUE
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
66574501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$725.80
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$461.12
|
| Rate for Payer: Group Health Inc Medicare |
$461.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
EP DBRIDMNT SKN/SUB TISSUE
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 11042
|
| Hospital Charge Code |
66574501
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
EP DDD/VDD IMPLANT
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
66574505
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
EP DDD/VDD IMPLANT
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33208
|
| Hospital Charge Code |
66574505
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$22,108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,108.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,348.58
|
| Rate for Payer: Aetna Government |
$12,348.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,644.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,644.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,644.01
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Cash Price |
$12,348.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,348.58
|
| 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 |
$12,348.58
|
| Rate for Payer: EmblemHealth Commercial |
$12,348.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,496.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,990.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,348.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,990.24
|
| Rate for Payer: Group Health Inc Commercial |
$12,348.58
|
| Rate for Payer: Group Health Inc Medicare |
$12,348.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,038.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,348.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,496.29
|
| Rate for Payer: Healthfirst QHP |
$12,348.58
|
| Rate for Payer: Humana Medicare |
$12,595.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,348.58
|
| Rate for Payer: United Healthcare Commercial |
$3,047.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,348.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,348.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,878.86
|
| Rate for Payer: Wellcare Medicare |
$11,731.15
|
|
|
EP ELC LT VENT PM/CRD-DFB
|
Facility
|
OP
|
$1,317.18
|
|
|
Service Code
|
HCPCS 33225
|
| Hospital Charge Code |
66574519
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$3,047.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$523.37
|
| Rate for Payer: Aetna Government |
$523.37
|
| Rate for Payer: Brighton Health Commercial |
$987.88
|
| 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 |
$658.59
|
| Rate for Payer: Group Health Inc Medicare |
$461.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$658.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$658.59
|
| Rate for Payer: United Healthcare Commercial |
$3,047.00
|
|
|
EP EPIC ABL W/O CARDI BYPAS
|
Facility
|
OP
|
$4,337.75
|
|
|
Service Code
|
HCPCS 33250
|
| Hospital Charge Code |
66574532
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$3,253.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,385.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,643.08
|
| Rate for Payer: Aetna Government |
$1,643.08
|
| Rate for Payer: Brighton Health Commercial |
$3,253.31
|
| 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 |
$2,168.88
|
| Rate for Payer: Group Health Inc Medicare |
$1,518.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,168.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,168.88
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
EP EXTERNAL EVENT UP TO 48HRS
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 93227
|
| Hospital Charge Code |
66574082
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$22.52 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.52
|
| Rate for Payer: Aetna Government |
$22.52
|
| Rate for Payer: Brighton Health Commercial |
$53.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.28
|
| Rate for Payer: Group Health Inc Commercial |
$35.50
|
| Rate for Payer: Group Health Inc Medicare |
$24.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.50
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
|
|
EP FOLY
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
66574547
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
EP FOLY
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 51702
|
| Hospital Charge Code |
66574547
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
EPHEDRINE 50 MG/ML INJ
|
Facility
|
OP
|
$3.63
|
|
| Hospital Charge Code |
41645212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.82
|
| Rate for Payer: Aetna Government |
$1.82
|
| Rate for Payer: Brighton Health Commercial |
$2.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.47
|
| Rate for Payer: Group Health Inc Commercial |
$1.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.36
|
|
|
EPHEDRINE 50 MG/ML INJ
|
Facility
|
OP
|
$3.63
|
|
| Hospital Charge Code |
41655212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.82
|
| Rate for Payer: Aetna Government |
$1.82
|
| Rate for Payer: Brighton Health Commercial |
$2.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.47
|
| Rate for Payer: Group Health Inc Commercial |
$1.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.36
|
|
