|
ERCP DIAGNOSTIC
|
Facility
|
IP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43260
|
| Hospital Charge Code |
41118921
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,428.82
|
|
|
ERCP WITH BIOPSY
|
Facility
|
IP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
40014288
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,428.82
|
|
|
ERCP WITH BIOPSY
|
Facility
|
IP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
41118922
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$4,428.82
|
|
|
ERCP WITH BIOPSY
|
Facility
|
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
40014288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,100.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,100.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,100.17
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Humana Medicare |
$4,517.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ERCP WITH BIOPSY
|
Facility
|
OP
|
$9,083.48
|
|
|
Service Code
|
HCPCS 43261
|
| Hospital Charge Code |
41118922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$4,541.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,428.82
|
| Rate for Payer: Aetna Government |
$4,428.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,100.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,100.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,100.17
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Cash Price |
$4,428.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,428.82
|
| 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 |
$4,428.82
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,764.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,941.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,428.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,941.65
|
| Rate for Payer: Group Health Inc Commercial |
$4,428.82
|
| Rate for Payer: Group Health Inc Medicare |
$4,428.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,541.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,428.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,764.50
|
| Rate for Payer: Healthfirst QHP |
$4,428.82
|
| Rate for Payer: Humana Medicare |
$4,517.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,428.82
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,428.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,428.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,543.06
|
| Rate for Payer: Wellcare Medicare |
$4,207.38
|
|
|
ER EM CRITICAL CARE
|
Facility
|
IP
|
$2,019.15
|
|
|
Service Code
|
HCPCS 99291 27
|
| Hospital Charge Code |
30106639
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,026.18
|
|
|
ER EM CRITICAL CARE
|
Facility
|
OP
|
$2,019.15
|
|
|
Service Code
|
HCPCS 99291 27
|
| Hospital Charge Code |
30106639
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,046.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,026.18
|
| Rate for Payer: Aetna Government |
$1,026.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$718.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$718.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$718.33
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,026.18
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Cash Price |
$1,026.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,026.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,026.18
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$872.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$913.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,026.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$913.30
|
| 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 |
$1,009.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,026.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,026.18
|
| Rate for Payer: Humana Medicare |
$1,046.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,026.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,026.18
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,026.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,026.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$820.94
|
| Rate for Payer: Wellcare Medicare |
$974.87
|
|
|
ER EM DETAILED
|
Facility
|
OP
|
$1,885.63
|
|
|
Service Code
|
HCPCS 99284 27
|
| Hospital Charge Code |
30106643
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$942.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$512.19
|
| Rate for Payer: Aetna Government |
$512.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$358.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$358.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$358.53
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$512.19
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Cash Price |
$512.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$512.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$512.19
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$455.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$512.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$455.85
|
| 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 |
$942.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$512.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$512.19
|
| Rate for Payer: Humana Medicare |
$522.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$512.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$512.19
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$512.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$512.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$409.75
|
| Rate for Payer: Wellcare Medicare |
$486.58
|
|
|
ER EM DETAILED
|
Facility
|
IP
|
$1,885.63
|
|
|
Service Code
|
HCPCS 99284 27
|
| Hospital Charge Code |
30106643
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$512.19
|
|
|
ER EM EXPANDED
|
Facility
|
OP
|
$1,246.36
|
|
|
Service Code
|
HCPCS 99283 27
|
| Hospital Charge Code |
30106645
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$329.95
|
| Rate for Payer: Aetna Government |
$329.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$230.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$230.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$230.96
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$329.95
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Cash Price |
$329.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$329.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$329.95
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$293.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$293.66
|
| 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 |
$623.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$329.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$329.95
|
| Rate for Payer: Humana Medicare |
$336.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$329.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$329.95
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$329.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$329.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$263.96
|
| Rate for Payer: Wellcare Medicare |
$313.45
|
|
|
ER EM EXPANDED
|
Facility
|
IP
|
$1,246.36
|
|
|
Service Code
|
HCPCS 99283 27
|
| Hospital Charge Code |
30106645
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$329.95
|
|
|
ER EM HIGH COMPLEX
|
Facility
|
IP
|
$3,480.31
|
|
|
Service Code
|
HCPCS 99285 27
|
| Hospital Charge Code |
30106644
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$742.78
|
|
|
ER EM HIGH COMPLEX
|
Facility
|
OP
|
$3,480.31
|
|
|
Service Code
|
HCPCS 99285 27
|
| Hospital Charge Code |
30106644
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,740.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$742.78
|
| Rate for Payer: Aetna Government |
$742.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$519.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$519.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$519.95
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$742.78
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Cash Price |
$742.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$742.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$742.78
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$631.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$661.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$661.07
|
| 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 |
$1,740.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$742.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$742.78
|
| Rate for Payer: Humana Medicare |
$757.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$742.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.78
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$742.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$594.22
|
| Rate for Payer: Wellcare Medicare |
$705.64
|
|
|
ER EM LOW COMPLEX
|
Facility
|
OP
|
$979.88
|
|
|
Service Code
|
HCPCS 99282 27
|
| Hospital Charge Code |
30106641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.39 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.13
|
| Rate for Payer: Aetna Government |
$189.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$132.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$132.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$132.39
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$189.13
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Cash Price |
$189.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$189.13
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.33
|
| 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 |
$489.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$189.13
|
| Rate for Payer: Humana Medicare |
$192.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.13
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$151.30
|
| Rate for Payer: Wellcare Medicare |
$179.67
|
|
|
ER EM LOW COMPLEX
|
Facility
|
IP
|
$979.88
|
|
|
Service Code
|
HCPCS 99282 27
|
| Hospital Charge Code |
30106641
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$189.13
|
|
|
ER EM STRAIGHTFORWARD
|
Facility
|
OP
|
$712.75
|
|
|
Service Code
|
HCPCS 99281 27
|
| Hospital Charge Code |
30106640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.67
|
| Rate for Payer: Aetna Government |
$102.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$71.87
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$102.67
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$102.67
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.38
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$102.67
|
| Rate for Payer: Humana Medicare |
$104.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.67
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.14
|
| Rate for Payer: Wellcare Medicare |
$97.54
|
|
|
ER EM STRAIGHTFORWARD
|
Facility
|
IP
|
$712.75
|
|
|
Service Code
|
HCPCS 99281 27
|
| Hospital Charge Code |
30106640
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$102.67
|
|
|
ERGOCALCIFEROL 1.25 MG (50000 UT) PO CAPS [2863]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
NDC 60687050001
|
| Hospital Charge Code |
60687050001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.96
|
| Rate for Payer: Aetna Government |
$0.96
|
| Rate for Payer: Brighton Health Commercial |
$1.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.96
|
| Rate for Payer: Group Health Inc Medicare |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
ERGOCALCIFEROL 1.25 MG (50000 UT) PO CAPS [2863]
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
64380073706
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$1.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.28
|
|
|
ERGOCALCIFEROL 200 MCG/ML PO SOLN [169410]
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
NDC 39328035760
|
| Hospital Charge Code |
39328035760
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Brighton Health Commercial |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.08
|
|
|
ERGOCALCIFEROL 200 MCG/ML PO SOLN [169410]
|
Facility
|
OP
|
$1.67
|
|
|
Service Code
|
NDC 47781064726
|
| Hospital Charge Code |
47781064726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.84
|
| Rate for Payer: Aetna Government |
$0.84
|
| Rate for Payer: Brighton Health Commercial |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.84
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
|
|
ERGOCALCIFEROL 50,000 INTL UNITS CAP
|
Facility
|
OP
|
$2.24
|
|
| Hospital Charge Code |
41641225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.12
|
| Rate for Payer: Aetna Government |
$1.12
|
| Rate for Payer: Brighton Health Commercial |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.46
|
|
|
ERGOCALCIFEROL 50,000 INTL UNITS CAP
|
Facility
|
OP
|
$2.24
|
|
| Hospital Charge Code |
41651225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.12
|
| Rate for Payer: Aetna Government |
$1.12
|
| Rate for Payer: Brighton Health Commercial |
$1.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.46
|
|
|
ERGOCALCIFEROL 8,000 INTL UNITS/ML LIQUI
|
Facility
|
OP
|
$122.00
|
|
| Hospital Charge Code |
41640945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$97.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.00
|
| Rate for Payer: Aetna Government |
$61.00
|
| Rate for Payer: Brighton Health Commercial |
$91.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.96
|
| Rate for Payer: Group Health Inc Commercial |
$61.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.30
|
|
|
ERGOCALCIFEROL 8,000 INTL UNITS/ML LIQUI
|
Facility
|
OP
|
$122.00
|
|
| Hospital Charge Code |
41650945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$97.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.00
|
| Rate for Payer: Aetna Government |
$61.00
|
| Rate for Payer: Brighton Health Commercial |
$91.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.96
|
| Rate for Payer: Group Health Inc Commercial |
$61.00
|
| Rate for Payer: Group Health Inc Medicare |
$42.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.30
|
|
