|
EPV EPI & ENDO PACE MAP
|
Facility
OP
|
$1,930.20
|
|
|
Service Code
|
HCPCS 93631 TC
|
| Hospital Charge Code |
66574584
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$675.57 |
| Max. Negotiated Rate |
$1,544.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,061.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$965.10
|
| Rate for Payer: Aetna Government |
$965.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,544.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,312.54
|
| Rate for Payer: Group Health Inc Commercial |
$965.10
|
| Rate for Payer: Group Health Inc Medicare |
$675.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$965.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$965.10
|
|
|
EPV EPS VIA ICD OR NIPS
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93799 TC
|
| Hospital Charge Code |
66574596
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$146.66 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| 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
|
|
|
EPV FLUORO UP TO 1 HOUR
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Hospital Charge Code |
66574550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.38 |
| 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 |
$31.38
|
| 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 |
$34.87
|
|
|
EPV HEMO ACCESS DUPLEX
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93990 TC
|
| Hospital Charge Code |
66574607
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.81 |
| 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 |
$137.44
|
| 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 |
$152.71
|
|
|
EPV HOLTER
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 93225 TC
|
| Hospital Charge Code |
66574557
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$115.58 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Government |
$165.12
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.56
|
| Rate for Payer: Group Health Inc Commercial |
$165.12
|
| Rate for Payer: Group Health Inc Medicare |
$115.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.12
|
|
|
EPV ICE
|
Facility
OP
|
$435.75
|
|
|
Service Code
|
HCPCS 93662 TC
|
| Hospital Charge Code |
66574594
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$152.51 |
| Max. Negotiated Rate |
$348.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$217.88
|
| Rate for Payer: Aetna Government |
$217.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$348.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$296.31
|
| Rate for Payer: Group Health Inc Commercial |
$217.88
|
| Rate for Payer: Group Health Inc Medicare |
$152.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.88
|
|
|
EPV ILIAC UNI/BYPASS GRAPH
|
Facility
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93979 TC
|
| Hospital Charge Code |
66574606
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$105.27 |
| 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 |
$105.27
|
| 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 |
$116.97
|
|
|
EPV INTCARD 3D MAPPING
|
Facility
OP
|
$1,095.55
|
|
|
Service Code
|
HCPCS 93613 TC
|
| Hospital Charge Code |
66574577
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$383.44 |
| Max. Negotiated Rate |
$876.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$602.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$547.78
|
| Rate for Payer: Aetna Government |
$547.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$876.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$744.97
|
| Rate for Payer: Group Health Inc Commercial |
$547.78
|
| Rate for Payer: Group Health Inc Medicare |
$383.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$547.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$547.78
|
|
|
EPV INT CARDIOVERSION
|
Facility
OP
|
$1,624.80
|
|
|
Service Code
|
HCPCS 92961 TC
|
| Hospital Charge Code |
66574553
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$568.68 |
| Max. Negotiated Rate |
$1,299.84 |
| 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: Cash Price |
$752.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,299.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,104.86
|
| 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 INTER DUL ICD W/WO PRO
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93283 TC
|
| Hospital Charge Code |
66574560
|
|
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 |
$48.38
|
| 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 |
$53.76
|
|
|
EPV INTER DVCE IMPLANT CA
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93289 TC
|
| Hospital Charge Code |
66574564
|
|
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 |
$41.00
|
| 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 |
$45.55
|
|
|
EPV INTER DVCE IMPLT CRDIO
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93290 TC
|
| Hospital Charge Code |
66574565
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$36.93 |
| 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 |
$36.93
|
| 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 |
$41.03
|
|
|
EPV INTER DVCE PACEMAKER
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93288 TC
|
| Hospital Charge Code |
66574563
|
|
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 |
$40.63
|
| 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 |
$45.14
|
|
|
EPV INTER DVCE WEAR DEFIB
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93292 TC
|
| Hospital Charge Code |
66574567
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$34.34 |
| 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 |
$34.34
|
| 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 |
$38.16
|
|
|
EPV INTER MUL ICD W/WO PRO
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93284 TC
|
| Hospital Charge Code |
66574561
|
|
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 |
$51.71
|
| 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 |
$57.46
|
|
|
EPV INTER SNG ICD W/WO PRO
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93282 TC
|
| Hospital Charge Code |
66574559
|
|
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 |
$44.32
|
| 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 |
$49.25
|
|
|
EPV INTER TO 90 INTERM ANAL
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93924 TC
|
| Hospital Charge Code |
66574569
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$146.66 |
| 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 |
$149.56
|
| 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 |
$166.18
|
|
|
EPV INTER TO 90 TECH REVW
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93296 TC
|
| Hospital Charge Code |
66574570
|
|
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: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| 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
|
|
|
EPV LE DOPPLER/PVR W/EXC
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93924 TC
|
| Hospital Charge Code |
66574598
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$146.66 |
| 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 |
$149.56
|
| 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 |
$166.18
|
|
|
EPV OTHER MECH ARTIAL FLTER
|
Facility
OP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 93655 TC
|
| Hospital Charge Code |
66574590
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$410.90 |
| Max. Negotiated Rate |
$939.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$645.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$587.00
|
| Rate for Payer: Aetna Government |
$587.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$939.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$798.32
|
| Rate for Payer: Group Health Inc Commercial |
$587.00
|
| Rate for Payer: Group Health Inc Medicare |
$410.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$587.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$587.00
|
|
|
EPV PROG POST DRUG INFUS
|
Facility
OP
|
$2,360.45
|
|
|
Service Code
|
HCPCS 93623 TC
|
| Hospital Charge Code |
66574583
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$826.16 |
| Max. Negotiated Rate |
$1,888.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,180.22
|
| Rate for Payer: Aetna Government |
$1,180.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,888.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,605.11
|
| Rate for Payer: Group Health Inc Commercial |
$1,180.22
|
| Rate for Payer: Group Health Inc Medicare |
$826.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.22
|
|
|
EPV REPROG IMPLT LOOP REC
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93285 TC
|
| Hospital Charge Code |
66574562
|
|
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 |
$39.89
|
| 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 |
$44.32
|
|
|
EPV TEE
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Hospital Charge Code |
66574573
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$146.30 |
| 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 |
$146.30
|
| 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 |
$162.56
|
|
|
EPV TILT TABLE
|
Facility
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 93660 TC
|
| Hospital Charge Code |
66574593
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$78.96 |
| 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 |
$78.96
|
| 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 |
$87.73
|
|
|
EPV TRANS RHYTHM STRIP PM
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93293 TC
|
| Hospital Charge Code |
66574568
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$35.08 |
| 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 |
$35.08
|
| 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 |
$38.98
|
|
