|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
IP
|
$24,954.46
|
|
|
Service Code
|
MS-DRG 147
|
| Min. Negotiated Rate |
$10,597.00 |
| Max. Negotiated Rate |
$24,954.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,221.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,465.16
|
| Rate for Payer: Aetna Government |
$24,465.16
|
| Rate for Payer: Brighton Health Commercial |
$17,919.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,954.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,341.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,611.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,241.90
|
| Rate for Payer: EmblemHealth Commercial |
$10,597.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,465.16
|
| Rate for Payer: Group Health Inc Commercial |
$24,465.16
|
| Rate for Payer: Group Health Inc Medicare |
$24,465.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,465.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,376.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,465.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,465.16
|
| Rate for Payer: Wellcare Medicare |
$23,241.90
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
IP
|
$37,333.92
|
|
|
Service Code
|
MS-DRG 146
|
| Min. Negotiated Rate |
$17,019.87 |
| Max. Negotiated Rate |
$37,333.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31,126.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,601.88
|
| Rate for Payer: Aetna Government |
$36,601.88
|
| Rate for Payer: Brighton Health Commercial |
$30,609.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,333.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36,454.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,084.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,771.79
|
| Rate for Payer: EmblemHealth Commercial |
$18,101.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,601.88
|
| Rate for Payer: Group Health Inc Commercial |
$36,601.88
|
| Rate for Payer: Group Health Inc Medicare |
$36,601.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,601.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,019.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,601.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,601.88
|
| Rate for Payer: Wellcare Medicare |
$34,771.79
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$20,058.94
|
|
|
Service Code
|
MS-DRG 148
|
| Min. Negotiated Rate |
$7,629.18 |
| Max. Negotiated Rate |
$20,058.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,118.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,665.63
|
| Rate for Payer: Aetna Government |
$19,665.63
|
| Rate for Payer: Brighton Health Commercial |
$12,900.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,058.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,364.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,679.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,682.35
|
| Rate for Payer: EmblemHealth Commercial |
$7,629.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,665.63
|
| Rate for Payer: Group Health Inc Commercial |
$19,665.63
|
| Rate for Payer: Group Health Inc Medicare |
$19,665.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,665.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,144.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,665.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,665.63
|
| Rate for Payer: Wellcare Medicare |
$18,682.35
|
|
|
EAR PROTECTOR ATTENUATION MEASURE
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 92596
|
| Hospital Charge Code |
42004526
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$90.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.38
|
| Rate for Payer: Aetna Government |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.38
|
| Rate for Payer: EmblemHealth Commercial |
$46.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Group Health Inc Commercial |
$46.38
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.42
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Wellcare Medicare |
$44.06
|
|
|
EBI OSTEO-GEN CATHODE ST DETACH
|
Facility
OP
|
$13,194.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$13,853.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,256.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,597.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,586.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,853.70
|
| Rate for Payer: Group Health Inc Commercial |
$6,597.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,617.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,597.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,597.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,576.10
|
|
|
EBI OSTEO-GEN CATHODE ST DETACH
|
Facility
IP
|
$13,194.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,597.00 |
| Max. Negotiated Rate |
$6,597.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,597.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,597.00
|
|
|
EBV AB VCA IGM
|
Facility
OP
|
$45.35
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
40729737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$28.83 |
| 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: 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 CHP/HARP/Medicaid |
$16.33
|
| 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 CHP/FHP/Medicaid |
$18.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$18.14
|
| Rate for Payer: Senior Whole Health 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
|
|
|
EBVCA(IGG+IGM)+EBVNIG
|
Facility
OP
|
$38.23
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
40729360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$24.31 |
| Rate for Payer: Healthfirst Medicare Advantage |
$15.29
|
| Rate for Payer: Healthfirst QHP |
$15.29
|
| 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: 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 CHP/HARP/Medicaid |
$13.76
|
| 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 CHP/FHP/Medicaid |
$15.29
|
| Rate for Payer: Senior Whole Health 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
|
|
|
EBVCA(IGG/M)
|
Facility
OP
|
$45.35
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
40729836
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$28.83 |
| 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: 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 CHP/HARP/Medicaid |
$16.33
|
| 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 CHP/FHP/Medicaid |
$18.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$18.14
|
| Rate for Payer: Senior Whole Health 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
|
|
|
EBV EARLY ANTIGEN AB IGG
|
Facility
OP
|
$32.80
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
40729736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$20.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.12
|
| Rate for Payer: Aetna Government |
$13.12
|
| Rate for Payer: Cash Price |
$13.12
|
| Rate for Payer: Cash Price |
$13.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.12
|
| Rate for Payer: EmblemHealth Commercial |
$13.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.68
|
| Rate for Payer: Group Health Inc Commercial |
$13.12
|
| Rate for Payer: Group Health Inc Medicare |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.12
|
| Rate for Payer: Healthfirst QHP |
$13.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.50
|
| Rate for Payer: Wellcare Medicare |
$11.81
|
|
|
ECG MONITOR/REPORT 24 HRS
|
Facility
OP
|
$714.57
|
|
|
Service Code
|
HCPCS 93224
|
| Hospital Charge Code |
40804112
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$79.36 |
| Max. Negotiated Rate |
$571.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.69
|
| Rate for Payer: Aetna Government |
$80.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$571.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$485.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.36
|
| Rate for Payer: Group Health Inc Commercial |
$357.28
|
| Rate for Payer: Group Health Inc Medicare |
$250.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$357.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.18
|
|
|
ECG TRACING ONLY W/O INT & REPORT
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
30101160
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
ECG TRANSMISSION - ANALYSIS
|
Facility
OP
|
$343.55
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
40801112
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$274.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.94
|
| Rate for Payer: Aetna Government |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$111.94
|
| Rate for Payer: EmblemHealth Commercial |
$111.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.63
|
| Rate for Payer: Group Health Inc Commercial |
$111.94
|
| Rate for Payer: Group Health Inc Medicare |
$111.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.15
|
| Rate for Payer: Healthfirst QHP |
$111.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$89.55
|
| Rate for Payer: Wellcare Medicare |
$106.34
|
|
|
ECG TRANSMISSION-ANALYSIS
|
Facility
OP
|
$343.55
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
30301164
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$89.55 |
| Max. Negotiated Rate |
$274.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.94
|
| Rate for Payer: Aetna Government |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$111.94
|
| Rate for Payer: EmblemHealth Commercial |
$111.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.63
|
| Rate for Payer: Group Health Inc Commercial |
$111.94
|
| Rate for Payer: Group Health Inc Medicare |
$111.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.15
|
| Rate for Payer: Healthfirst QHP |
$111.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$89.55
|
| Rate for Payer: Wellcare Medicare |
$106.34
|
|
|
E. CHAFFEENSIS-HME (MONOCYCTIC)
|
Facility
OP
|
$25.45
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
40729361
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.18
|
| Rate for Payer: Healthfirst QHP |
$10.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.14
|
| Rate for Payer: Wellcare Medicare |
$9.16
|
|
|
ECHCARDIOGRAPH TRANSTHORACIC
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
30105304
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$143.65 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.65
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.61
|
|
|
ECHINOCOCCUS ANTIBODY
|
Facility
OP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40729367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.01
|
| Rate for Payer: EmblemHealth Commercial |
$13.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.58
|
| Rate for Payer: Group Health Inc Commercial |
$13.01
|
| Rate for Payer: Group Health Inc Medicare |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.01
|
| Rate for Payer: Healthfirst QHP |
$13.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.41
|
| Rate for Payer: Wellcare Medicare |
$11.71
|
|
|
ECHINOCOCCUS GRANULOSUS AB (IGG),
|
Facility
OP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40728346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$20.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.01
|
| Rate for Payer: EmblemHealth Commercial |
$13.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.58
|
| Rate for Payer: Group Health Inc Commercial |
$13.01
|
| Rate for Payer: Group Health Inc Medicare |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.01
|
| Rate for Payer: Healthfirst QHP |
$13.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.41
|
| Rate for Payer: Wellcare Medicare |
$11.71
|
|
|
ECHO 2D
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Hospital Charge Code |
30301312
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.54
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.15
|
|
|
ECHOCARDIOGRAM-M MODE & 2D
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Hospital Charge Code |
40802000
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$104.54 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$352.92
|
| Rate for Payer: Aetna Government |
$352.92
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.54
|
| Rate for Payer: Group Health Inc Commercial |
$352.92
|
| Rate for Payer: Group Health Inc Medicare |
$247.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.15
|
|
|
Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report
|
Facility
OP
|
$6,937.00
|
|
|
Service Code
|
CPT 93312
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$253.37 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,959.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,215.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$253.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$637.97
|
| Rate for Payer: Group Health Inc Medicare |
$637.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
ECHO COLOR FLOW
|
Facility
OP
|
$171.78
|
|
|
Service Code
|
HCPCS 93325 TC
|
| Hospital Charge Code |
30301303
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$137.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.89
|
| Rate for Payer: Aetna Government |
$85.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$137.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.54
|
| Rate for Payer: Group Health Inc Commercial |
$85.89
|
| Rate for Payer: Group Health Inc Medicare |
$60.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.05
|
|
|
ECHO DOPPLER
|
Facility
OP
|
$243.43
|
|
|
Service Code
|
HCPCS 93320 TC
|
| Hospital Charge Code |
30301313
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$194.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.72
|
| Rate for Payer: Aetna Government |
$121.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$194.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.93
|
| Rate for Payer: Group Health Inc Commercial |
$121.72
|
| Rate for Payer: Group Health Inc Medicare |
$85.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.03
|
|
|
ECHO EXAMINATION OF EYE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76516 TC
|
| Hospital Charge Code |
30306404
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$27.32 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.32
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.35
|
|
|
ECHO EXAM OF EYE
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76519 TC
|
| Hospital Charge Code |
30305684
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$271.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$169.72
|
| Rate for Payer: Aetna Government |
$169.72
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.73
|
| Rate for Payer: Group Health Inc Commercial |
$169.72
|
| Rate for Payer: Group Health Inc Medicare |
$118.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.37
|
|
