|
EPV CATH ABLATION TRET VT
|
Facility
OP
|
$61,893.33
|
|
|
Service Code
|
HCPCS 93654 TC
|
| Hospital Charge Code |
66574589
|
|
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 MAPPING
|
Facility
OP
|
$1,153.50
|
|
|
Service Code
|
HCPCS 93609 TC
|
| Hospital Charge Code |
66574576
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$403.72 |
| Max. Negotiated Rate |
$922.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$634.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$576.75
|
| Rate for Payer: Aetna Government |
$576.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$922.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$784.38
|
| Rate for Payer: Group Health Inc Commercial |
$576.75
|
| Rate for Payer: Group Health Inc Medicare |
$403.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$576.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$576.75
|
|
|
EPV COM BILAT EXTREM VEINS
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
66574603
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$173.96 |
| 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 |
$173.96
|
| 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 |
$193.29
|
|
|
EPV COM EPS ADD LV TO EPS
|
Facility
OP
|
$2,393.07
|
|
|
Service Code
|
HCPCS 93622 TC
|
| Hospital Charge Code |
66574582
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$837.57 |
| Max. Negotiated Rate |
$1,914.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,316.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,196.54
|
| Rate for Payer: Aetna Government |
$1,196.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,914.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,627.29
|
| Rate for Payer: Group Health Inc Commercial |
$1,196.54
|
| Rate for Payer: Group Health Inc Medicare |
$837.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,196.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,196.54
|
|
|
EPV COM EPS AD LA TO EPS
|
Facility
OP
|
$5,737.67
|
|
|
Service Code
|
HCPCS 93621 TC
|
| Hospital Charge Code |
66574581
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,008.18 |
| Max. Negotiated Rate |
$4,590.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,155.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,868.84
|
| Rate for Payer: Aetna Government |
$2,868.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,590.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,901.62
|
| Rate for Payer: Group Health Inc Commercial |
$2,868.84
|
| Rate for Payer: Group Health Inc Medicare |
$2,008.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,868.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,868.84
|
|
|
EPV COM EPS IND OR ATTMPT
|
Facility
OP
|
$17,826.35
|
|
|
Service Code
|
HCPCS 93620 TC
|
| Hospital Charge Code |
66574580
|
|
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 COMP EPS W/O INDUCT
|
Facility
OP
|
$17,826.35
|
|
|
Service Code
|
HCPCS 93619 TC
|
| Hospital Charge Code |
66574579
|
|
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 COMPLETE ECHO
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
66574572
|
|
Hospital Revenue Code
|
731
|
| 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
|
|
|
EPV COM UNILAT EXTREM VEIN
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Hospital Charge Code |
66574604
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$109.71 |
| 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 |
$109.71
|
| 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 |
$121.90
|
|
|
EPV DFT AFTER IMPLANT
|
Facility
OP
|
$2,991.08
|
|
|
Service Code
|
HCPCS 93642 TC
|
| Hospital Charge Code |
66574586
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$92.64 |
| Max. Negotiated Rate |
$2,392.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,645.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,495.54
|
| Rate for Payer: Aetna Government |
$1,495.54
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,392.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,033.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.64
|
| Rate for Payer: Group Health Inc Commercial |
$1,495.54
|
| Rate for Payer: Group Health Inc Medicare |
$1,046.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,495.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,495.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.93
|
|
|
EPV DFT/PACE W/IMPLT DEV
|
Facility
OP
|
$947.20
|
|
|
Service Code
|
HCPCS 93641 TC
|
| Hospital Charge Code |
66574585
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$331.52 |
| Max. Negotiated Rate |
$757.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$520.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$473.60
|
| Rate for Payer: Aetna Government |
$473.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$757.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$644.10
|
| Rate for Payer: Group Health Inc Commercial |
$473.60
|
| Rate for Payer: Group Health Inc Medicare |
$331.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$473.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$473.60
|
|
|
EPV ECHO DURING STRESS
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93350 TC
|
| Hospital Charge Code |
66574574
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$131.15 |
| 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 |
$131.15
|
| 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 |
$145.72
|
|
|
EPV EEG
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95812 TC
|
| Hospital Charge Code |
66574650
|
|
Hospital Revenue Code
|
740
|
| 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: 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: Fidelis CHP/HARP/Medicaid |
$321.81
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$357.57
|
|
|
EPV EKG
|
Facility
OP
|
$145.50
|
|
|
Service Code
|
HCPCS 93000 TC
|
| Hospital Charge Code |
66574554
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$50.92 |
| Max. Negotiated Rate |
$116.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.75
|
| Rate for Payer: Aetna Government |
$72.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.94
|
| Rate for Payer: Group Health Inc Commercial |
$72.75
|
| Rate for Payer: Group Health Inc Medicare |
$50.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.75
|
|
|
EPV EMG 11-12 NERVE
|
Facility
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95912 TC
|
| Hospital Charge Code |
66574658
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$103.43 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$735.40
|
| Rate for Payer: Aetna Government |
$735.40
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.43
|
| Rate for Payer: Group Health Inc Commercial |
$735.40
|
| Rate for Payer: Group Health Inc Medicare |
$514.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.92
|
|
|
EPV EMG 1-2 NERVES
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95907 TC
|
| Hospital Charge Code |
66574653
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$42.10 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.10
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.78
|
|
|
EPV EMG 3-4 NERVES
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95908 TC
|
| Hospital Charge Code |
66574654
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$52.08 |
| 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: 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: Fidelis CHP/HARP/Medicaid |
$52.08
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.87
|
|
|
EPV EMG 5-6 NERVES
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95909 TC
|
| Hospital Charge Code |
66574655
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$62.43 |
| 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: 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: Fidelis CHP/HARP/Medicaid |
$62.43
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.37
|
|
|
EPV EMG 5 OR MORE MUSCLES
|
Facility
OP
|
$149.35
|
|
|
Service Code
|
HCPCS 95886 TC
|
| Hospital Charge Code |
66574651
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$52.27 |
| Max. Negotiated Rate |
$119.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.68
|
| Rate for Payer: Aetna Government |
$74.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$101.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.40
|
| Rate for Payer: Group Health Inc Commercial |
$74.68
|
| Rate for Payer: Group Health Inc Medicare |
$52.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.89
|
|
|
EPV EMG 7-8 NERVES
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 95910 TC
|
| Hospital Charge Code |
66574656
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$79.80 |
| 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: 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: Fidelis CHP/HARP/Medicaid |
$79.80
|
| 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
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.67
|
|
|
EPV EMG 9-10 NERVES
|
Facility
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95911 TC
|
| Hospital Charge Code |
66574657
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$91.64 |
| Max. Negotiated Rate |
$1,176.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$735.40
|
| Rate for Payer: Aetna Government |
$735.40
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.64
|
| Rate for Payer: Group Health Inc Commercial |
$735.40
|
| Rate for Payer: Group Health Inc Medicare |
$514.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.82
|
|
|
EPV EMS BLINKS
|
Facility
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 95933 TC
|
| Hospital Charge Code |
66574659
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$57.26 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.30
|
| Rate for Payer: Aetna Government |
$83.30
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$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: Fidelis CHP/HARP/Medicaid |
$57.26
|
| Rate for Payer: Group Health Inc Commercial |
$83.30
|
| Rate for Payer: Group Health Inc Medicare |
$58.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.62
|
|
|
EPV EMS BLINKS
|
Facility
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 95933 TC
|
| Hospital Charge Code |
66574617
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$57.26 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$770.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$700.00
|
| Rate for Payer: Aetna Government |
$700.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,120.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$952.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.26
|
| Rate for Payer: Group Health Inc Commercial |
$700.00
|
| Rate for Payer: Group Health Inc Medicare |
$490.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.62
|
|
|
EPV EMS LIMITED MUSCLES
|
Facility
OP
|
$210.35
|
|
|
Service Code
|
HCPCS 95887 TC
|
| Hospital Charge Code |
66574652
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$168.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.18
|
| Rate for Payer: Aetna Government |
$105.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.12
|
| Rate for Payer: Group Health Inc Commercial |
$105.18
|
| Rate for Payer: Group Health Inc Medicare |
$73.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.91
|
|
|
EPV EMS RNS
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95937 TC
|
| Hospital Charge Code |
66574660
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.43
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.26
|
|
