|
EP INSJ PERQ VAD L HRT ARTERIAL
|
Facility
|
OP
|
$1,255.40
|
|
|
Service Code
|
HCPCS 33990
|
| Hospital Charge Code |
66574540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$690.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$494.35
|
| Rate for Payer: Aetna Government |
$494.35
|
| Rate for Payer: Brighton Health Commercial |
$941.55
|
| 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 |
$627.70
|
| Rate for Payer: Group Health Inc Medicare |
$439.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$627.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$627.70
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
EP INSJ PERQ VAD L HRT ARTL&VEN
|
Facility
|
OP
|
$1,829.12
|
|
|
Service Code
|
HCPCS 33991
|
| Hospital Charge Code |
66574541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$640.19 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,006.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$719.78
|
| Rate for Payer: Aetna Government |
$719.78
|
| Rate for Payer: Brighton Health Commercial |
$1,371.84
|
| 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 |
$914.56
|
| Rate for Payer: Group Health Inc Medicare |
$640.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$914.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$914.56
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
EP INS PM P-GEN ONLY W/SNG
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
66574508
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
EP INS PM P-GEN ONLY W/SNG
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33212
|
| Hospital Charge Code |
66574508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,134.00 |
| Max. Negotiated Rate |
$17,358.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,824.59
|
| Rate for Payer: Aetna Government |
$9,824.59
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,877.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,877.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,877.21
|
| Rate for Payer: Brighton Health Commercial |
$17,358.94
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,824.59
|
| 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 |
$9,824.59
|
| Rate for Payer: EmblemHealth Commercial |
$9,824.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,350.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,743.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,824.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,743.89
|
| Rate for Payer: Group Health Inc Commercial |
$9,824.59
|
| Rate for Payer: Group Health Inc Medicare |
$9,824.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,824.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,350.90
|
| Rate for Payer: Healthfirst QHP |
$9,824.59
|
| Rate for Payer: Humana Medicare |
$10,021.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,824.59
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,824.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,824.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,859.67
|
| Rate for Payer: Wellcare Medicare |
$9,333.36
|
|
|
EP INS PM P-GEN ONNLY W/DUL
|
Facility
|
OP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
66574509
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,134.00 |
| Max. Negotiated Rate |
$23,287.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| 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 INS PM P-GEN ONNLY W/DUL
|
Facility
|
IP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33213
|
| Hospital Charge Code |
66574509
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
EPIRUBICIN 200 MG/100 ML INJ
|
Facility
|
OP
|
$4,820.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41653777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3,133.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,651.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.69
|
| Rate for Payer: Aetna Government |
$1.69
|
| Rate for Payer: Brighton Health Commercial |
$2,892.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,410.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,771.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,410.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,687.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,410.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,410.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.41
|
| Rate for Payer: SOMOS Essential |
$1.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,133.00
|
|
|
EPIRUBICIN 200 MG/100 ML INJ
|
Facility
|
OP
|
$4,820.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41643777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3,133.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,651.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.69
|
| Rate for Payer: Aetna Government |
$1.69
|
| Rate for Payer: Brighton Health Commercial |
$2,892.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,410.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,771.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,410.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,687.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,410.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,410.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.41
|
| Rate for Payer: SOMOS Essential |
$1.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,133.00
|
|
|
EPIRUBICIN 200 MG/100 ML INJ
|
Facility
|
IP
|
$4,820.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41653777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,410.00 |
| Max. Negotiated Rate |
$2,410.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,410.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,410.00
|
|
|
EPIRUBICIN 200 MG/100 ML INJ
|
Facility
|
IP
|
$4,820.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41643777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,410.00 |
| Max. Negotiated Rate |
$2,410.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,410.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,410.00
|
|
|
EPIRUBICIN 50 MG/25 ML INJ
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41643776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$783.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$662.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.69
|
| Rate for Payer: Aetna Government |
$1.69
|
| Rate for Payer: Brighton Health Commercial |
$723.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$602.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$692.88
|
| Rate for Payer: Group Health Inc Commercial |
$602.50
|
| Rate for Payer: Group Health Inc Medicare |
$421.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.41
|
| Rate for Payer: SOMOS Essential |
$1.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$783.25
|
|
|
EPIRUBICIN 50 MG/25 ML INJ
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41643776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$602.50 |
| Max. Negotiated Rate |
$602.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.50
|
|
|
EPIRUBICIN 50 MG/25 ML INJ
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41653776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$602.50 |
| Max. Negotiated Rate |
$602.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.50
|
|
|
EPIRUBICIN 50 MG/25 ML INJ
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS J9178
|
| Hospital Charge Code |
41653776
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$783.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$662.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.69
|
| Rate for Payer: Aetna Government |
$1.69
|
| Rate for Payer: Brighton Health Commercial |
$723.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$602.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$692.88
|
| Rate for Payer: Group Health Inc Commercial |
$602.50
|
| Rate for Payer: Group Health Inc Medicare |
$421.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$602.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$602.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.41
|
| Rate for Payer: SOMOS Essential |
$1.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$783.25
|
|
|
EPISIOTOMY OF VAGINAL REPAIR
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
30107831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$3,783.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,615.39
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| 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 |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,615.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
EPISIOTOMY OF VAGINAL REPAIR
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59300
|
| Hospital Charge Code |
30107831
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$35,140.23
|
|
|
Service Code
|
MSDRG 150
|
| Min. Negotiated Rate |
$11,271.80 |
| Max. Negotiated Rate |
$35,140.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,382.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,556.53
|
| Rate for Payer: Aetna Government |
$25,556.53
|
| Rate for Payer: Brighton Health Commercial |
$19,060.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,067.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,700.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,733.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,278.70
|
| Rate for Payer: EmblemHealth Commercial |
$11,271.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,556.53
|
| Rate for Payer: Group Health Inc Commercial |
$25,556.53
|
| Rate for Payer: Group Health Inc Medicare |
$25,556.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,556.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,883.79
|
| Rate for Payer: Humana Medicare |
$35,140.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,556.53
|
| Rate for Payer: United Healthcare Commercial |
$26,141.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,556.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,556.53
|
| Rate for Payer: Wellcare Medicare |
$24,278.70
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$24,771.22
|
|
|
Service Code
|
MSDRG 151
|
| Min. Negotiated Rate |
$6,608.75 |
| Max. Negotiated Rate |
$24,771.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,363.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,015.43
|
| Rate for Payer: Aetna Government |
$18,015.43
|
| Rate for Payer: Brighton Health Commercial |
$11,175.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,375.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,309.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,983.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,114.66
|
| Rate for Payer: EmblemHealth Commercial |
$6,608.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,015.43
|
| Rate for Payer: Group Health Inc Commercial |
$18,015.43
|
| Rate for Payer: Group Health Inc Medicare |
$18,015.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,015.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,377.17
|
| Rate for Payer: Humana Medicare |
$24,771.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,015.43
|
| Rate for Payer: United Healthcare Commercial |
$15,326.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,015.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,015.43
|
| Rate for Payer: Wellcare Medicare |
$17,114.66
|
|
|
EPOESTIN ALFA ESRD 4,000 U
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS Q4105
|
| Hospital Charge Code |
41656875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.90
|
| Rate for Payer: Aetna Government |
$39.90
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.07
|
| Rate for Payer: SOMOS Essential |
$26.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
EPOESTIN ALFA ESRD 4,000 U
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS Q4105
|
| Hospital Charge Code |
41656875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
EPOETIN ALFA 10000 UNIT/ML IJ SOLN [9938]
|
Facility
|
OP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
55513014401
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.26
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Brighton Health Commercial |
$149.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$159.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$135.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Humana Medicare |
$9.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.26
|
| Rate for Payer: SOMOS Essential |
$12.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$27.58
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.49
|
| Rate for Payer: United Healthcare Medicaid |
$12.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN ALFA 10000 UNIT/ML IJ SOLN [9938]
|
Facility
|
OP
|
$198.96
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
55513014410
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$109.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.26
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Brighton Health Commercial |
$149.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$159.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$135.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Humana Medicare |
$9.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.26
|
| Rate for Payer: SOMOS Essential |
$12.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$27.58
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.49
|
| Rate for Payer: United Healthcare Medicaid |
$12.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN ALFA 10000 UNIT/ML IJ SOLN [9938]
|
Facility
|
OP
|
$320.70
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
59676031001
|
|
Hospital Revenue Code
|
635
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.26
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Brighton Health Commercial |
$240.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$256.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Humana Medicare |
$9.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.26
|
| Rate for Payer: SOMOS Essential |
$12.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$27.58
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.49
|
| Rate for Payer: United Healthcare Medicaid |
$12.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN ALFA 2000 UNIT/ML IJ SOLN [9939]
|
Facility
|
OP
|
$39.79
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
55513012610
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.26
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Brighton Health Commercial |
$29.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Humana Medicare |
$9.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.26
|
| Rate for Payer: SOMOS Essential |
$12.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$27.58
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.49
|
| Rate for Payer: United Healthcare Medicaid |
$12.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN ALFA 2000 UNIT/ML IJ SOLN [9939]
|
Facility
|
OP
|
$64.15
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
59676030201
|
|
Hospital Revenue Code
|
634
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.89
|
| Rate for Payer: Aetna Government |
$8.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.26
|
| Rate for Payer: Amida Care Medicaid |
$12.26
|
| Rate for Payer: Brighton Health Commercial |
$48.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.89
|
| Rate for Payer: EmblemHealth Commercial |
$8.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.87
|
| Rate for Payer: Group Health Inc Commercial |
$8.89
|
| Rate for Payer: Group Health Inc Medicare |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.26
|
| Rate for Payer: Healthfirst Essential Plan |
$27.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.55
|
| Rate for Payer: Healthfirst QHP |
$12.26
|
| Rate for Payer: Humana Medicare |
$9.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.26
|
| Rate for Payer: SOMOS Essential |
$12.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$27.58
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$13.49
|
| Rate for Payer: United Healthcare Medicaid |
$12.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
