|
EP RMV/REP CRD-DFB MULTI
|
Facility
|
OP
|
$97,776.05
|
|
|
Service Code
|
HCPCS 33264
|
| Hospital Charge Code |
66574536
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$73,332.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,045.24
|
| Rate for Payer: Aetna Government |
$38,045.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$26,631.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$26,631.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,631.67
|
| Rate for Payer: Brighton Health Commercial |
$73,332.04
|
| Rate for Payer: Cash Price |
$38,045.24
|
| Rate for Payer: Cash Price |
$38,045.24
|
| Rate for Payer: Cash Price |
$38,045.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38,045.24
|
| 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 |
$38,045.24
|
| Rate for Payer: EmblemHealth Commercial |
$38,045.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32,338.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33,860.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,045.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,860.26
|
| Rate for Payer: Group Health Inc Commercial |
$38,045.24
|
| Rate for Payer: Group Health Inc Medicare |
$38,045.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48,888.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,045.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32,338.45
|
| Rate for Payer: Healthfirst QHP |
$38,045.24
|
| Rate for Payer: Humana Medicare |
$38,806.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,045.24
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,045.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,045.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30,436.19
|
| Rate for Payer: Wellcare Medicare |
$36,142.98
|
|
|
EP RMV/REP CRD-DFB MULTI
|
Facility
|
IP
|
$97,776.05
|
|
|
Service Code
|
HCPCS 33264
|
| Hospital Charge Code |
66574536
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$38,045.24
|
|
|
EP RMV/REP CRD-DFB SGNL
|
Facility
|
IP
|
$68,791.68
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
66574534
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$27,258.51
|
|
|
EP RMV/REP CRD-DFB SGNL
|
Facility
|
OP
|
$68,791.68
|
|
|
Service Code
|
HCPCS 33262
|
| Hospital Charge Code |
66574534
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$51,593.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,258.51
|
| Rate for Payer: Aetna Government |
$27,258.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19,080.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19,080.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,080.96
|
| Rate for Payer: Brighton Health Commercial |
$51,593.76
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Cash Price |
$27,258.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,258.51
|
| 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 |
$27,258.51
|
| Rate for Payer: EmblemHealth Commercial |
$27,258.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23,169.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24,260.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,258.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,260.07
|
| Rate for Payer: Group Health Inc Commercial |
$27,258.51
|
| Rate for Payer: Group Health Inc Medicare |
$27,258.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,395.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,258.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,169.73
|
| Rate for Payer: Healthfirst QHP |
$27,258.51
|
| Rate for Payer: Humana Medicare |
$27,803.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,258.51
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,258.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,258.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,806.81
|
| Rate for Payer: Wellcare Medicare |
$25,895.58
|
|
|
EP RMV/REP PM P-GEN DUAL
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
66574522
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$12,348.58
|
|
|
EP RMV/REP PM P-GEN DUAL
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
HCPCS 33228
|
| Hospital Charge Code |
66574522
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$22,557.00 |
| 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 |
$22,557.00
|
| 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 |
$3,190.00
|
| 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 RMV/REP PM P-GEN MULTI
|
Facility
|
OP
|
$55,466.18
|
|
|
Service Code
|
HCPCS 33229
|
| Hospital Charge Code |
66574523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,477.75 |
| Max. Negotiated Rate |
$41,599.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,533.14
|
| Rate for Payer: Aetna Government |
$22,533.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15,773.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15,773.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15,773.20
|
| Rate for Payer: Brighton Health Commercial |
$41,599.64
|
| Rate for Payer: Cash Price |
$22,533.14
|
| Rate for Payer: Cash Price |
$22,533.14
|
| Rate for Payer: Cash Price |
$22,533.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,533.14
|
| 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 |
$22,533.14
|
| Rate for Payer: EmblemHealth Commercial |
$22,533.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19,153.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20,054.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,533.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20,054.49
|
| Rate for Payer: Group Health Inc Commercial |
$22,533.14
|
| Rate for Payer: Group Health Inc Medicare |
$22,533.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,733.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,533.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,153.17
|
| Rate for Payer: Healthfirst QHP |
$22,533.14
|
| Rate for Payer: Humana Medicare |
$22,983.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,533.14
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,533.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,533.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,026.51
|
| Rate for Payer: Wellcare Medicare |
$21,406.48
|
|
|
EP RMV/REP PM P-GEN MULTI
|
Facility
|
IP
|
$55,466.18
|
|
|
Service Code
|
HCPCS 33229
|
| Hospital Charge Code |
66574523
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$22,533.14
|
|
|
EP RMV/REP PM P-GEN SNGL
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
66574521
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
EP RMV/REP PM P-GEN SNGL
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
66574521
|
|
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 |
$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 RMV SNGL LEAD AND PG
|
Facility
|
IP
|
$9,037.83
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
66574526
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$4,541.28
|
|
|
EP RMV SNGL LEAD AND PG
|
Facility
|
OP
|
$9,037.83
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
66574526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,835.00 |
| Max. Negotiated Rate |
$6,778.37 |
| 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 |
$6,778.37
|
| 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 |
$4,518.92
|
| 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
|
|
|
EPSTEIN-BARR NUCLEAR ANTIGEN
|
Facility
|
IP
|
$38.23
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
40729630
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$15.29
|
|
|
EPSTEIN-BARR NUCLEAR ANTIGEN
|
Facility
|
OP
|
$38.23
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
40729630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$28.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.29
|
| Rate for Payer: Aetna Government |
$15.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.70
|
| Rate for Payer: Brighton Health Commercial |
$28.67
|
| Rate for Payer: Cash Price |
$15.29
|
| Rate for Payer: Cash Price |
$15.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.29
|
| Rate for Payer: EmblemHealth Commercial |
$15.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.61
|
| Rate for Payer: Group Health Inc Commercial |
$15.29
|
| Rate for Payer: Group Health Inc Medicare |
$15.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.29
|
| Rate for Payer: Healthfirst QHP |
$15.29
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.29
|
| Rate for Payer: United Healthcare Commercial |
$19.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.23
|
| Rate for Payer: Wellcare Medicare |
$13.76
|
|
|
EPSTEIN-BARR VIRUS DNA
|
Facility
|
IP
|
$295.43
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40618285
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$35.09
|
|
|
EPSTEIN-BARR VIRUS DNA
|
Facility
|
OP
|
$295.43
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40618285
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$221.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$162.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$221.57
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
EPSTEIN BARR VIRUS EACH ANTIGN
|
Facility
|
IP
|
$45.35
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
40617693
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$18.14
|
|
|
EPSTEIN BARR VIRUS EACH ANTIGN
|
Facility
|
OP
|
$45.35
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
40617693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$34.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.14
|
| Rate for Payer: Aetna Government |
$18.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.70
|
| Rate for Payer: Brighton Health Commercial |
$34.01
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.14
|
| Rate for Payer: EmblemHealth Commercial |
$18.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.14
|
| Rate for Payer: Group Health Inc Commercial |
$18.14
|
| Rate for Payer: Group Health Inc Medicare |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$18.14
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare Commercial |
$22.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.51
|
| Rate for Payer: Wellcare Medicare |
$16.33
|
|
|
EPSTEIN-BARR VIRUS PCR
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40729401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
EPSTEIN-BARR VIRUS PCR
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40729401
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$35.09
|
|
|
EP TEMP PM SNG CHAMBER
|
Facility
|
IP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
66574506
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$9,824.59
|
|
|
EP TEMP PM SNG CHAMBER
|
Facility
|
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
66574506
|
|
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
|
|
|
EPTIFIBATIDE 0.75 MG/ML INFUSION 100 ML
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41653635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.34
|
| Rate for Payer: Brighton Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.35
|
| Rate for Payer: EmblemHealth Commercial |
$3.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.51
|
| Rate for Payer: Group Health Inc Commercial |
$3.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.84
|
| Rate for Payer: Healthfirst QHP |
$3.35
|
| Rate for Payer: Humana Medicare |
$3.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.68
|
| Rate for Payer: Wellcare Medicare |
$3.18
|
|
|
EPTIFIBATIDE 0.75 MG/ML INFUSION 100 ML
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41643635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.34
|
| Rate for Payer: Brighton Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.35
|
| Rate for Payer: EmblemHealth Commercial |
$3.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.51
|
| Rate for Payer: Group Health Inc Commercial |
$3.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.84
|
| Rate for Payer: Healthfirst QHP |
$3.35
|
| Rate for Payer: Humana Medicare |
$3.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.68
|
| Rate for Payer: Wellcare Medicare |
$3.18
|
|
|
EPTIFIBATIDE 0.75 MG/ML INFUSION 100 ML
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41653635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
