|
ESOMEPRAZOLE 40 MG INJ
|
Facility
|
IP
|
$9.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41654369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
|
|
ESOMEPRAZOLE 40 MG INJ
|
Facility
|
IP
|
$9.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41644369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
|
|
ESOMEPRAZOLE 40 MG INJ
|
Facility
|
OP
|
$9.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41644369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.72
|
| Rate for Payer: Aetna Government |
$4.72
|
| Rate for Payer: Brighton Health Commercial |
$5.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.42
|
| Rate for Payer: Group Health Inc Commercial |
$4.72
|
| Rate for Payer: Group Health Inc Medicare |
$3.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.13
|
|
|
ESOMEPRAZOLE 40 MG INJ
|
Facility
|
OP
|
$9.43
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41654369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.72
|
| Rate for Payer: Aetna Government |
$4.72
|
| Rate for Payer: Brighton Health Commercial |
$5.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.42
|
| Rate for Payer: Group Health Inc Commercial |
$4.72
|
| Rate for Payer: Group Health Inc Medicare |
$3.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.13
|
|
|
ESOMEPRAZOLE 40MG IV PED - 5MG
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41647083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
ESOMEPRAZOLE 40MG IV PED - 5MG
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41647083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.75
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
ESOMEPRAZOLE 40MG IV PED - 5MG
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41657083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.75
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.50
|
|
|
ESOMEPRAZOLE 40MG IV PED - 5MG
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41657083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]
|
Facility
|
OP
|
$8.52
|
|
|
Service Code
|
NDC 31722066530
|
| Hospital Charge Code |
31722066530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.26
|
| Rate for Payer: Aetna Government |
$4.26
|
| Rate for Payer: Brighton Health Commercial |
$6.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.80
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.54
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
NDC 43598051030
|
| Hospital Charge Code |
43598051030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.51
|
| Rate for Payer: Aetna Government |
$4.51
|
| Rate for Payer: Brighton Health Commercial |
$6.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.14
|
| Rate for Payer: Group Health Inc Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Medicare |
$3.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.87
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]
|
Facility
|
OP
|
$8.52
|
|
|
Service Code
|
NDC 00093645198
|
| Hospital Charge Code |
00093645198
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.26
|
| Rate for Payer: Aetna Government |
$4.26
|
| Rate for Payer: Brighton Health Commercial |
$6.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.54
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]
|
Facility
|
OP
|
$8.52
|
|
|
Service Code
|
NDC 00093645156
|
| Hospital Charge Code |
00093645156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.26
|
| Rate for Payer: Aetna Government |
$4.26
|
| Rate for Payer: Brighton Health Commercial |
$6.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.80
|
| Rate for Payer: Group Health Inc Commercial |
$4.26
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.54
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
NDC 63304073530
|
| Hospital Charge Code |
63304073530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.51
|
| Rate for Payer: Aetna Government |
$4.51
|
| Rate for Payer: Brighton Health Commercial |
$6.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.14
|
| Rate for Payer: Group Health Inc Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Medicare |
$3.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.87
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]
|
Facility
|
OP
|
$8.83
|
|
|
Service Code
|
NDC 67877057290
|
| Hospital Charge Code |
67877057290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.42
|
| Rate for Payer: Aetna Government |
$4.42
|
| Rate for Payer: Brighton Health Commercial |
$6.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.01
|
| Rate for Payer: Group Health Inc Commercial |
$4.42
|
| Rate for Payer: Group Health Inc Medicare |
$3.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.74
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
NDC 68382044206
|
| Hospital Charge Code |
68382044206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.51
|
| Rate for Payer: Aetna Government |
$4.51
|
| Rate for Payer: Brighton Health Commercial |
$6.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.14
|
| Rate for Payer: Group Health Inc Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Medicare |
$3.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.87
|
|
|
ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]
|
Facility
|
OP
|
$9.02
|
|
|
Service Code
|
NDC 68462039130
|
| Hospital Charge Code |
68462039130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.51
|
| Rate for Payer: Aetna Government |
$4.51
|
| Rate for Payer: Brighton Health Commercial |
$6.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.14
|
| Rate for Payer: Group Health Inc Commercial |
$4.51
|
| Rate for Payer: Group Health Inc Medicare |
$3.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.87
|
|
|
ESOMEPRAZOLE SACHET GRANULES 10 MG
|
Facility
|
OP
|
$4.95
|
|
| Hospital Charge Code |
41655152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Brighton Health Commercial |
$3.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.37
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.22
|
|
|
ESOMEPRAZOLE SACHET GRANULES 10 MG
|
Facility
|
OP
|
$4.95
|
|
| Hospital Charge Code |
41645152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Brighton Health Commercial |
$3.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.37
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.22
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$34,400.37
|
|
|
Service Code
|
MSDRG 391
|
| Min. Negotiated Rate |
$10,939.10 |
| Max. Negotiated Rate |
$34,400.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,810.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,018.45
|
| Rate for Payer: Aetna Government |
$25,018.45
|
| Rate for Payer: Brighton Health Commercial |
$18,497.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,518.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,030.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,180.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,767.53
|
| Rate for Payer: EmblemHealth Commercial |
$10,939.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,018.45
|
| Rate for Payer: Group Health Inc Commercial |
$25,018.45
|
| Rate for Payer: Group Health Inc Medicare |
$25,018.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,018.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,633.58
|
| Rate for Payer: Humana Medicare |
$34,400.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,018.45
|
| Rate for Payer: United Healthcare Commercial |
$25,369.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,018.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,018.45
|
| Rate for Payer: Wellcare Medicare |
$23,767.53
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$25,055.33
|
|
|
Service Code
|
MSDRG 392
|
| Min. Negotiated Rate |
$6,736.52 |
| Max. Negotiated Rate |
$25,055.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,583.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,222.06
|
| Rate for Payer: Aetna Government |
$18,222.06
|
| Rate for Payer: Brighton Health Commercial |
$11,391.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,586.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,566.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,195.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,310.96
|
| Rate for Payer: EmblemHealth Commercial |
$6,736.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,222.06
|
| Rate for Payer: Group Health Inc Commercial |
$18,222.06
|
| Rate for Payer: Group Health Inc Medicare |
$18,222.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,222.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,473.26
|
| Rate for Payer: Humana Medicare |
$25,055.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,222.06
|
| Rate for Payer: United Healthcare Commercial |
$15,623.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,222.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,222.06
|
| Rate for Payer: Wellcare Medicare |
$17,310.96
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,540.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,540.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,540.32
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Humana Medicare |
$2,244.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,540.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,540.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,540.32
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Humana Medicare |
$2,244.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 43237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,200.46
|
| Rate for Payer: Aetna Government |
$2,200.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,540.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,540.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,540.32
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.46
|
| 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 |
$2,200.46
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,870.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,958.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,958.41
|
| Rate for Payer: Group Health Inc Commercial |
$2,200.46
|
| Rate for Payer: Group Health Inc Medicare |
$2,200.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.39
|
| Rate for Payer: Healthfirst QHP |
$2,200.46
|
| Rate for Payer: Humana Medicare |
$2,244.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.46
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,200.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,760.37
|
| Rate for Payer: Wellcare Medicare |
$2,090.44
|
|
