|
COVID-19 VACCINE(PFZ TRIS SUCROS)
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 91300
|
| Hospital Charge Code |
41650290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
COVID COUNSEL TO UNVACCINATED
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
HCPCS 99429
|
| Hospital Charge Code |
30301433
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.25 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.25
|
| Rate for Payer: Aetna Government |
$31.25
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.25
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
COVID COUNSEL TO UNVACC-TELE
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
HCPCS 99429 GQ
|
| Hospital Charge Code |
30301434
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.25 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.25
|
| Rate for Payer: Aetna Government |
$31.25
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.25
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
COXSACKIE A IGG/IGM ANTIBODY
|
Facility
|
OP
|
$32.58
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
40729359
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.60
|
| Rate for Payer: Group Health Inc Commercial |
$13.03
|
| Rate for Payer: Group Health Inc Medicare |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.03
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: Humana Medicare |
$13.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.42
|
| Rate for Payer: Wellcare Medicare |
$11.73
|
|
|
COXSACKIE A IGG/IGM ANTIBODY
|
Facility
|
IP
|
$32.58
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
40729359
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.03
|
|
|
COXSACKIE A VIRUS ANTIBODIES
|
Facility
|
OP
|
$32.58
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
40617684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Cash Price |
$13.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.60
|
| Rate for Payer: Group Health Inc Commercial |
$13.03
|
| Rate for Payer: Group Health Inc Medicare |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.03
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: Humana Medicare |
$13.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.42
|
| Rate for Payer: Wellcare Medicare |
$11.73
|
|
|
COXSACKIE A VIRUS ANTIBODIES
|
Facility
|
IP
|
$32.58
|
|
|
Service Code
|
HCPCS 86658
|
| Hospital Charge Code |
40617684
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.03
|
|
|
COXSACKIE VIRUS GROUP B AB
|
Facility
|
OP
|
$69.93
|
|
| Hospital Charge Code |
40729845
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$55.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.96
|
| Rate for Payer: Aetna Government |
$34.96
|
| Rate for Payer: Brighton Health Commercial |
$52.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.55
|
| Rate for Payer: Group Health Inc Commercial |
$34.96
|
| Rate for Payer: Group Health Inc Medicare |
$24.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.96
|
|
|
CP4 LO HI TISSUE EXPAND 350
|
Facility
|
OP
|
$3,662.50
|
|
| Hospital Charge Code |
64905951
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,281.88 |
| Max. Negotiated Rate |
$2,930.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,014.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,831.25
|
| Rate for Payer: Aetna Government |
$1,831.25
|
| Rate for Payer: Brighton Health Commercial |
$2,746.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,930.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,490.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,831.25
|
| Rate for Payer: Group Health Inc Medicare |
$1,281.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,831.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,831.25
|
|
|
CPAP MASK
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
40306800
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
CPAP MASK
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
40306800
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
CP DOBUTAMINE NUC STRESS TEST
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
41507602
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$697.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
CP DOBUTAMINE NUC STRESS TEST
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
41507602
|
|
Hospital Revenue Code
|
482
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
CP ECHOCARDIOGRAM
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
41508700
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
CP ECHOCARDIOGRAM
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
41508700
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$446.58 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$1,093.94
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| 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 |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| 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 Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CP ECHO M-MODE 2D
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Hospital Charge Code |
41502875
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
CP ECHO M-MODE 2D
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Hospital Charge Code |
41502875
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
CP ECHO W BUBBLE
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
41502876
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
CP ECHO W BUBBLE
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
41502876
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$446.58 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$1,093.94
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| 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 |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| 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 Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CP ECHO W COLOR DOPPLER
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
41502877
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
CP ECHO W COLOR DOPPLER
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
41502877
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$446.58 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$1,093.94
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| 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 |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| 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 Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CP ECHO W DOPPLER F/U OR LIMITED
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
41502874
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
CP ECHO W DOPPLER F/U OR LIMITED
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
41502874
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
CP EEG AWAKE
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
41502878
|
|
Hospital Revenue Code
|
740
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
CP EEG AWAKE
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
41502878
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$254.09 |
| Max. Negotiated Rate |
$822.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
