|
EPOETIN FOR ESRD 3,000 UNITS/ML INJ
|
Facility
|
OP
|
$33.34
|
|
| Hospital Charge Code |
41654350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.67
|
| Rate for Payer: Aetna Government |
$16.67
|
| Rate for Payer: Brighton Health Commercial |
$25.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$16.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
|
|
EPOETIN FOR ESRD 4,000 UNITS/ML INJ
|
Facility
|
OP
|
$37.92
|
|
| Hospital Charge Code |
41644351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
| Rate for Payer: Aetna Government |
$18.96
|
| Rate for Payer: Brighton Health Commercial |
$28.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.79
|
| Rate for Payer: Group Health Inc Commercial |
$18.96
|
| Rate for Payer: Group Health Inc Medicare |
$13.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.65
|
|
|
EPOETIN FOR ESRD 4,000 UNITS/ML INJ
|
Facility
|
OP
|
$37.92
|
|
| Hospital Charge Code |
41654351
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
| Rate for Payer: Aetna Government |
$18.96
|
| Rate for Payer: Brighton Health Commercial |
$28.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.79
|
| Rate for Payer: Group Health Inc Commercial |
$18.96
|
| Rate for Payer: Group Health Inc Medicare |
$13.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.65
|
|
|
EPOETIN FOR NON ESRD 10,000 UNITS/ML INJ
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
41653712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
| Rate for Payer: Aetna Government |
$20.50
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.88
|
| Rate for Payer: Group Health Inc Commercial |
$20.50
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.65
|
|
|
EPOETIN FOR NON ESRD 10,000 UNITS/ML INJ
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
41643712
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
| Rate for Payer: Aetna Government |
$20.50
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.88
|
| Rate for Payer: Group Health Inc Commercial |
$20.50
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.65
|
|
|
EPOETIN FOR NON ESRD 20,000 UNITS/2 ML I
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41645567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.05
|
| 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 |
$126.60
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| 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 |
$105.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.32
|
| 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 |
$105.50
|
| 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 Commercial |
$8.25
|
| 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 |
$137.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN FOR NON ESRD 20,000 UNITS/2 ML I
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41655567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$105.50 |
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
|
|
EPOETIN FOR NON ESRD 20,000 UNITS/2 ML I
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41645567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$105.50 |
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.50
|
|
|
EPOETIN FOR NON ESRD 20,000 UNITS/2 ML I
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
41655567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$1,226.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.05
|
| 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 |
$126.60
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cash Price |
$8.89
|
| 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 |
$105.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.32
|
| 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 |
$105.50
|
| 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 Commercial |
$8.25
|
| 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 |
$137.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.11
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
|
|
EPOETIN FOR NON ESRD 2,000 UNITS/ML INJ
|
Facility
|
OP
|
$36.27
|
|
| Hospital Charge Code |
41643709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.14
|
| Rate for Payer: Aetna Government |
$18.14
|
| Rate for Payer: Brighton Health Commercial |
$27.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.66
|
| Rate for Payer: Group Health Inc Commercial |
$18.14
|
| Rate for Payer: Group Health Inc Medicare |
$12.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.58
|
|
|
EPOETIN FOR NON ESRD 2,000 UNITS/ML INJ
|
Facility
|
OP
|
$36.27
|
|
| Hospital Charge Code |
41653709
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.14
|
| Rate for Payer: Aetna Government |
$18.14
|
| Rate for Payer: Brighton Health Commercial |
$27.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.66
|
| Rate for Payer: Group Health Inc Commercial |
$18.14
|
| Rate for Payer: Group Health Inc Medicare |
$12.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.58
|
|
|
EPOETIN FOR NON ESRD 3,000 UNITS/ML INJ
|
Facility
|
OP
|
$33.34
|
|
| Hospital Charge Code |
41653710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.67
|
| Rate for Payer: Aetna Government |
$16.67
|
| Rate for Payer: Brighton Health Commercial |
$25.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$16.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
|
|
EPOETIN FOR NON ESRD 3,000 UNITS/ML INJ
|
Facility
|
OP
|
$33.34
|
|
| Hospital Charge Code |
41643710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$26.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.67
|
| Rate for Payer: Aetna Government |
$16.67
|
| Rate for Payer: Brighton Health Commercial |
$25.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$16.67
|
| Rate for Payer: Group Health Inc Medicare |
$11.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.67
|
|
|
EPOETIN FOR NON ESRD 40,000 UNITS/ML INJ
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
41653713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
| Rate for Payer: Aetna Government |
$20.50
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.88
|
| Rate for Payer: Group Health Inc Commercial |
$20.50
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.65
|
|
|
EPOETIN FOR NON ESRD 40,000 UNITS/ML INJ
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
41643713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$32.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.50
|
| Rate for Payer: Aetna Government |
$20.50
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.88
|
| Rate for Payer: Group Health Inc Commercial |
$20.50
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.65
|
|
|
EPOETIN FOR NON ESRD 4,000 UNITS/ML INJ
|
Facility
|
OP
|
$36.17
|
|
| Hospital Charge Code |
41643711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$28.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.08
|
| Rate for Payer: Aetna Government |
$18.08
|
| Rate for Payer: Brighton Health Commercial |
$27.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.60
|
| Rate for Payer: Group Health Inc Commercial |
$18.08
|
| Rate for Payer: Group Health Inc Medicare |
$12.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.51
|
|
|
EPOETIN FOR NON ESRD 4,000 UNITS/ML INJ
|
Facility
|
OP
|
$36.17
|
|
| Hospital Charge Code |
41653711
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$28.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.08
|
| Rate for Payer: Aetna Government |
$18.08
|
| Rate for Payer: Brighton Health Commercial |
$27.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.60
|
| Rate for Payer: Group Health Inc Commercial |
$18.08
|
| Rate for Payer: Group Health Inc Medicare |
$12.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.51
|
|
|
EP PACE TEP PERC DUAL
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33211
|
| Hospital Charge Code |
66574507
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$17,358.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| 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 |
$2,546.00
|
| 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 PACE TEP PERC DUAL
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33211
|
| Hospital Charge Code |
66574507
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
EP PEIC ABL W/CARDI BYPAS
|
Facility
|
OP
|
$4,772.55
|
|
|
Service Code
|
HCPCS 33251
|
| Hospital Charge Code |
66574533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$3,579.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,624.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,814.49
|
| Rate for Payer: Aetna Government |
$1,814.49
|
| Rate for Payer: Brighton Health Commercial |
$3,579.41
|
| 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 |
$2,386.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,670.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,386.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,386.28
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
EP PM UPGRADE SNG TO DUL
|
Facility
|
IP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
66574510
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
EP PM UPGRADE SNG TO DUL
|
Facility
|
OP
|
$31,050.58
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
66574510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$23,287.94 |
| 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 |
$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 |
$3,047.00
|
| 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 REAPIR TWO ELECTRODES
|
Facility
|
IP
|
$7,169.88
|
|
|
Service Code
|
HCPCS 33220
|
| Hospital Charge Code |
66574515
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,541.28
|
|
|
EP REAPIR TWO ELECTRODES
|
Facility
|
OP
|
$7,169.88
|
|
|
Service Code
|
HCPCS 33220
|
| Hospital Charge Code |
66574515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$5,377.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,541.28
|
| Rate for Payer: Aetna Government |
$4,541.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,178.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,178.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,178.90
|
| Rate for Payer: Brighton Health Commercial |
$5,377.41
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,541.28
|
| 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 |
$4,541.28
|
| Rate for Payer: EmblemHealth Commercial |
$4,541.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,860.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,041.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,541.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,041.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,541.28
|
| Rate for Payer: Group Health Inc Medicare |
$4,541.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,584.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,541.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,860.09
|
| Rate for Payer: Healthfirst QHP |
$4,541.28
|
| Rate for Payer: Humana Medicare |
$4,632.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,541.28
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,541.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,541.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,633.02
|
| Rate for Payer: Wellcare Medicare |
$4,314.22
|
|
|
EP REMOVAL OF PG ALONE
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
66574525
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$17,358.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$1,835.00
|
| 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
|
|
