|
EP RMV SNGL LEAD AND PG
|
Facility
OP
|
$9,037.83
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
66574526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$549.69 |
| Max. Negotiated Rate |
$4,541.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,541.28
|
| Rate for Payer: Aetna Government |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Cash Price |
$4,541.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,541.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,541.28
|
| Rate for Payer: EmblemHealth Commercial |
$4,541.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$549.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,860.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,041.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,541.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,041.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,541.28
|
| Rate for Payer: Group Health Inc Medicare |
$4,541.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,518.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,541.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,860.09
|
| Rate for Payer: Healthfirst QHP |
$4,541.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,541.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,541.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,633.02
|
| Rate for Payer: Wellcare Medicare |
$4,314.22
|
|
|
EPSTEIN-BARR NUCLEAR ANTIGEN
|
Facility
OP
|
$38.23
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
40729630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$24.31 |
| 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: Healthfirst Medicare Advantage |
$15.29
|
| Rate for Payer: Healthfirst QHP |
$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
|
|
|
EPSTEIN-BARR VIRUS DNA
|
Facility
OP
|
$295.43
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40618285
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$162.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$162.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
EPSTEIN BARR VIRUS EACH ANTIGN
|
Facility
OP
|
$45.35
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
40617693
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
EPSTEIN-BARR VIRUS PCR
|
Facility
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40729401
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$55.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
EP TEMP PM SNG CHAMBER
|
Facility
OP
|
$23,145.25
|
|
|
Service Code
|
HCPCS 33210
|
| Hospital Charge Code |
66574506
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.07 |
| Max. Negotiated Rate |
$11,572.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,824.59
|
| Rate for Payer: Aetna Government |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Cash Price |
$9,824.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,824.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$9,824.59
|
| Rate for Payer: EmblemHealth Commercial |
$9,824.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,350.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,743.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,824.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,743.89
|
| Rate for Payer: Group Health Inc Commercial |
$9,824.59
|
| Rate for Payer: Group Health Inc Medicare |
$9,824.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,824.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,350.90
|
| Rate for Payer: Healthfirst QHP |
$9,824.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,824.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,824.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7,859.67
|
| Rate for Payer: Wellcare Medicare |
$9,333.36
|
|
|
EPTIFIBATIDE 0.75 MG/ML INFUSION 100 ML
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41643635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.35
|
| Rate for Payer: EmblemHealth Commercial |
$3.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.51
|
| Rate for Payer: Group Health Inc Commercial |
$3.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.84
|
| Rate for Payer: Healthfirst QHP |
$3.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.68
|
| Rate for Payer: Wellcare Medicare |
$3.18
|
|
|
EPTIFIBATIDE 0.75 MG/ML INFUSION 100 ML
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41653635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.35
|
| Rate for Payer: EmblemHealth Commercial |
$3.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.51
|
| Rate for Payer: Group Health Inc Commercial |
$3.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.84
|
| Rate for Payer: Healthfirst QHP |
$3.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.68
|
| Rate for Payer: Wellcare Medicare |
$3.18
|
|
|
EPTIFIBATIDE 0.75 MG/ML INFUSION 100 ML
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41653635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
|
EPTIFIBATIDE 0.75 MG/ML INFUSION 100 ML
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41643635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
|
EPTIFIBATIDE 2000 MCG/ML INJ
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41653636
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
|
EPTIFIBATIDE 2000 MCG/ML INJ
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41653636
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.35
|
| Rate for Payer: EmblemHealth Commercial |
$3.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.51
|
| Rate for Payer: Group Health Inc Commercial |
$3.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.84
|
| Rate for Payer: Healthfirst QHP |
$3.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.68
|
| Rate for Payer: Wellcare Medicare |
$3.18
|
|
|
EPTIFIBATIDE 2000 MCG/ML INJ
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41643636
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.35
|
| Rate for Payer: Aetna Government |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$60.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.35
|
| Rate for Payer: EmblemHealth Commercial |
$3.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.51
|
| Rate for Payer: Group Health Inc Commercial |
$3.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.84
|
| Rate for Payer: Healthfirst QHP |
$3.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2.68
|
| Rate for Payer: Wellcare Medicare |
$3.18
|
|
|
EPTIFIBATIDE 2000 MCG/ML INJ
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
41643636
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
|
EP TRANS BALOON ANGIOPLAS
|
Facility
OP
|
$4,502.50
|
|
|
Service Code
|
HCPCS 33476
|
| Hospital Charge Code |
66574539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,575.88 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,476.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,717.69
|
| Rate for Payer: Aetna Government |
$1,717.69
|
| 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: Fidelis CHP/HARP/Medicaid |
$1,744.79
|
| Rate for Payer: Group Health Inc Commercial |
$2,251.25
|
| Rate for Payer: Group Health Inc Medicare |
$1,575.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,251.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,251.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,938.66
|
|
|
EPV ABLATION ATRIOV NODE
|
Facility
OP
|
$17,826.35
|
|
|
Service Code
|
HCPCS 93650 TC
|
| Hospital Charge Code |
66574587
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$6,239.22 |
| Max. Negotiated Rate |
$14,261.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,804.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,913.18
|
| Rate for Payer: Aetna Government |
$8,913.18
|
| Rate for Payer: Cash Price |
$8,636.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,261.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,121.92
|
| Rate for Payer: Group Health Inc Commercial |
$8,913.18
|
| Rate for Payer: Group Health Inc Medicare |
$6,239.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,913.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,913.18
|
|
|
EPV ADJ IMP OPT VAL ANA
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93279 TC
|
| Hospital Charge Code |
66574558
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.36
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.96
|
|
|
EPV AORTA DUPLEX
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93978 TC
|
| Hospital Charge Code |
66574605
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$159.91 |
| 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 |
$159.91
|
| 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 |
$177.68
|
|
|
EPV ART DUPLEX BYPASS UNI
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93931 TC
|
| Hospital Charge Code |
66574601
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$112.30 |
| 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 |
$112.30
|
| 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 |
$124.78
|
|
|
EPV ARTERIAL DUPLEX
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93930 TC
|
| Hospital Charge Code |
66574600
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$176.91 |
| 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 |
$176.91
|
| 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 |
$196.57
|
|
|
EPV CARDIAC STRESS
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 93017 TC
|
| Hospital Charge Code |
66574555
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$268.30 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
| Rate for Payer: Aetna Government |
$383.29
|
| Rate for Payer: Cash Price |
$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: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
|
|
EPV CARDIOVER ELEV ELECT
|
Facility
OP
|
$1,624.80
|
|
|
Service Code
|
HCPCS 92960 TC
|
| Hospital Charge Code |
66574552
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$568.68 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$893.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$812.40
|
| Rate for Payer: Aetna Government |
$812.40
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$752.63
|
| Rate for Payer: Cash Price |
$752.63
|
| 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: Group Health Inc Commercial |
$812.40
|
| Rate for Payer: Group Health Inc Medicare |
$568.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$812.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$812.40
|
|
|
EPV CAROTID DUPLEX
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93880 TC
|
| Hospital Charge Code |
66574597
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$171.37 |
| 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 |
$171.37
|
| 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 |
$190.41
|
|
|
EPV CATH ABLATION TRET PVI
|
Facility
OP
|
$61,893.33
|
|
|
Service Code
|
HCPCS 93656 TC
|
| Hospital Charge Code |
66574591
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21,662.67 |
| Max. Negotiated Rate |
$49,514.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34,041.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,946.66
|
| Rate for Payer: Aetna Government |
$30,946.66
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49,514.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42,087.46
|
| Rate for Payer: Group Health Inc Commercial |
$30,946.66
|
| Rate for Payer: Group Health Inc Medicare |
$21,662.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,946.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,946.66
|
|
|
EPV CATH ABLATION TRET SVT
|
Facility
OP
|
$61,893.33
|
|
|
Service Code
|
HCPCS 93653 TC
|
| Hospital Charge Code |
66574588
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21,662.67 |
| Max. Negotiated Rate |
$49,514.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34,041.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,946.66
|
| Rate for Payer: Aetna Government |
$30,946.66
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49,514.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42,087.46
|
| Rate for Payer: Group Health Inc Commercial |
$30,946.66
|
| Rate for Payer: Group Health Inc Medicare |
$21,662.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,946.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,946.66
|
|
