|
E ANTIGEN TYPE
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701251
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
|
IP
|
$33,639.60
|
|
|
Service Code
|
MSDRG 147
|
| Min. Negotiated Rate |
$10,597.00 |
| Max. Negotiated Rate |
$33,639.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,221.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,465.16
|
| Rate for Payer: Aetna Government |
$24,465.16
|
| Rate for Payer: Brighton Health Commercial |
$17,919.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,954.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,341.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,611.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,241.90
|
| Rate for Payer: EmblemHealth Commercial |
$10,597.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,465.16
|
| Rate for Payer: Group Health Inc Commercial |
$24,465.16
|
| Rate for Payer: Group Health Inc Medicare |
$24,465.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,465.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,376.30
|
| Rate for Payer: Humana Medicare |
$33,639.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,465.16
|
| Rate for Payer: United Healthcare Commercial |
$24,576.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,465.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,465.16
|
| Rate for Payer: Wellcare Medicare |
$23,241.90
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
|
IP
|
$50,327.58
|
|
|
Service Code
|
MSDRG 146
|
| Min. Negotiated Rate |
$17,019.87 |
| Max. Negotiated Rate |
$50,327.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31,126.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,601.88
|
| Rate for Payer: Aetna Government |
$36,601.88
|
| Rate for Payer: Brighton Health Commercial |
$30,609.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,333.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36,454.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,084.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,771.79
|
| Rate for Payer: EmblemHealth Commercial |
$18,101.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,601.88
|
| Rate for Payer: Group Health Inc Commercial |
$36,601.88
|
| Rate for Payer: Group Health Inc Medicare |
$36,601.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,601.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,019.87
|
| Rate for Payer: Humana Medicare |
$50,327.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,601.88
|
| Rate for Payer: United Healthcare Commercial |
$41,981.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,601.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,601.88
|
| Rate for Payer: Wellcare Medicare |
$34,771.79
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$27,040.24
|
|
|
Service Code
|
MSDRG 148
|
| Min. Negotiated Rate |
$7,629.18 |
| Max. Negotiated Rate |
$27,040.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,118.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,665.63
|
| Rate for Payer: Aetna Government |
$19,665.63
|
| Rate for Payer: Brighton Health Commercial |
$12,900.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,058.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,364.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,679.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,682.35
|
| Rate for Payer: EmblemHealth Commercial |
$7,629.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,665.63
|
| Rate for Payer: Group Health Inc Commercial |
$19,665.63
|
| Rate for Payer: Group Health Inc Medicare |
$19,665.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,665.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,144.52
|
| Rate for Payer: Humana Medicare |
$27,040.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,665.63
|
| Rate for Payer: United Healthcare Commercial |
$17,693.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,665.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,665.63
|
| Rate for Payer: Wellcare Medicare |
$18,682.35
|
|
|
EAR PROTECTOR ATTENUATION MEASURE
|
Facility
|
IP
|
$101.25
|
|
|
Service Code
|
HCPCS 92596
|
| Hospital Charge Code |
42004526
|
|
Hospital Revenue Code
|
471
|
| Rate for Payer: Cash Price |
$46.38
|
|
|
EAR PROTECTOR ATTENUATION MEASURE
|
Facility
|
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 92596
|
| Hospital Charge Code |
42004526
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.38
|
| Rate for Payer: Aetna Government |
$46.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$32.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$32.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.47
|
| Rate for Payer: Brighton Health Commercial |
$75.94
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.38
|
| Rate for Payer: EmblemHealth Commercial |
$46.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Group Health Inc Commercial |
$46.38
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.42
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: Humana Medicare |
$47.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Wellcare Medicare |
$44.06
|
|
|
EBI OSTEO-GEN CATHODE ST DETACH
|
Facility
|
OP
|
$13,194.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$13,853.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,256.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$7,916.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,597.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,586.55
|
| Rate for Payer: EmblemHealth Commercial |
$6,597.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,853.70
|
| Rate for Payer: Group Health Inc Commercial |
$6,597.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,617.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,597.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,597.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,576.10
|
|
|
EBI OSTEO-GEN CATHODE ST DETACH
|
Facility
|
IP
|
$13,194.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40208102
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,597.00 |
| Max. Negotiated Rate |
$6,597.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,597.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,597.00
|
|
|
EBV AB VCA IGM
|
Facility
|
OP
|
$45.35
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
40729737
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$34.01 |
| 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: Affinity Essential Plan 1&2 |
$12.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.70
|
| Rate for Payer: Brighton Health Commercial |
$34.01
|
| 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 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 Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$18.14
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare Commercial |
$22.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.51
|
| Rate for Payer: Wellcare Medicare |
$16.33
|
|
|
EBV AB VCA IGM
|
Facility
|
IP
|
$45.35
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
40729737
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$18.14
|
|
|
EBVCA(IGG+IGM)+EBVNIG
|
Facility
|
IP
|
$38.23
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
40729360
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$15.29
|
|
|
EBVCA(IGG+IGM)+EBVNIG
|
Facility
|
OP
|
$38.23
|
|
|
Service Code
|
HCPCS 86664
|
| Hospital Charge Code |
40729360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$28.67 |
| 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: Affinity Essential Plan 1&2 |
$10.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.70
|
| Rate for Payer: Brighton Health Commercial |
$28.67
|
| 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 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 Medicare Advantage |
$15.29
|
| Rate for Payer: Healthfirst QHP |
$15.29
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.29
|
| Rate for Payer: United Healthcare Commercial |
$19.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.23
|
| Rate for Payer: Wellcare Medicare |
$13.76
|
|
|
EBVCA(IGG/M)
|
Facility
|
IP
|
$45.35
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
40729836
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$18.14
|
|
|
EBVCA(IGG/M)
|
Facility
|
OP
|
$45.35
|
|
|
Service Code
|
HCPCS 86665
|
| Hospital Charge Code |
40729836
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$34.01 |
| 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: Affinity Essential Plan 1&2 |
$12.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.70
|
| Rate for Payer: Brighton Health Commercial |
$34.01
|
| 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 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 Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$18.14
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare Commercial |
$22.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.51
|
| Rate for Payer: Wellcare Medicare |
$16.33
|
|
|
EBV EARLY ANTIGEN AB IGG
|
Facility
|
OP
|
$32.80
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
40729736
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$24.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.12
|
| Rate for Payer: Aetna Government |
$13.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.18
|
| Rate for Payer: Brighton Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$13.12
|
| Rate for Payer: Cash Price |
$13.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.12
|
| Rate for Payer: EmblemHealth Commercial |
$13.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.68
|
| Rate for Payer: Group Health Inc Commercial |
$13.12
|
| Rate for Payer: Group Health Inc Medicare |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.12
|
| Rate for Payer: Healthfirst QHP |
$13.12
|
| Rate for Payer: Humana Medicare |
$13.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.12
|
| Rate for Payer: United Healthcare Commercial |
$16.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.50
|
| Rate for Payer: Wellcare Medicare |
$11.81
|
|
|
EBV EARLY ANTIGEN AB IGG
|
Facility
|
IP
|
$32.80
|
|
|
Service Code
|
HCPCS 86663
|
| Hospital Charge Code |
40729736
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$13.12
|
|
|
ECG MONITOR/REPORT 24 HRS
|
Facility
|
OP
|
$714.57
|
|
|
Service Code
|
HCPCS 93224
|
| Hospital Charge Code |
40804112
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$80.69 |
| Max. Negotiated Rate |
$571.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.69
|
| Rate for Payer: Aetna Government |
$80.69
|
| Rate for Payer: Brighton Health Commercial |
$535.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$571.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$485.91
|
| Rate for Payer: Group Health Inc Commercial |
$357.28
|
| Rate for Payer: Group Health Inc Medicare |
$250.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$357.28
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
|
|
ECG TRACING ONLY W/O INT & REPORT
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
30101160
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
ECG TRACING ONLY W/O INT & REPORT
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 93041
|
| Hospital Charge Code |
30101160
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$133.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$124.95
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
ECG TRANSMISSION - ANALYSIS
|
Facility
|
OP
|
$343.55
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
40801112
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$274.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.94
|
| Rate for Payer: Aetna Government |
$111.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$78.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$78.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$78.36
|
| Rate for Payer: Brighton Health Commercial |
$257.66
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$111.94
|
| Rate for Payer: EmblemHealth Commercial |
$111.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.63
|
| Rate for Payer: Group Health Inc Commercial |
$111.94
|
| Rate for Payer: Group Health Inc Medicare |
$111.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.15
|
| Rate for Payer: Healthfirst QHP |
$111.94
|
| Rate for Payer: Humana Medicare |
$114.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.94
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$89.55
|
| Rate for Payer: Wellcare Medicare |
$106.34
|
|
|
ECG TRANSMISSION - ANALYSIS
|
Facility
|
IP
|
$343.55
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
40801112
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$111.94
|
|
|
ECG TRANSMISSION-ANALYSIS
|
Facility
|
IP
|
$343.55
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
30301164
|
|
Hospital Revenue Code
|
730
|
| Rate for Payer: Cash Price |
$111.94
|
|
|
ECG TRANSMISSION-ANALYSIS
|
Facility
|
OP
|
$343.55
|
|
|
Service Code
|
HCPCS 93271
|
| Hospital Charge Code |
30301164
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$274.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.94
|
| Rate for Payer: Aetna Government |
$111.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$78.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$78.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$78.36
|
| Rate for Payer: Brighton Health Commercial |
$257.66
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Cash Price |
$111.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.61
|
| Rate for Payer: Elderplan Medicare Advantage |
$111.94
|
| Rate for Payer: EmblemHealth Commercial |
$111.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.63
|
| Rate for Payer: Group Health Inc Commercial |
$111.94
|
| Rate for Payer: Group Health Inc Medicare |
$111.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.15
|
| Rate for Payer: Healthfirst QHP |
$111.94
|
| Rate for Payer: Humana Medicare |
$114.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.94
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$89.55
|
| Rate for Payer: Wellcare Medicare |
$106.34
|
|
|
E. CHAFFEENSIS-HME (MONOCYCTIC)
|
Facility
|
OP
|
$25.45
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
40729361
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.13
|
| Rate for Payer: Brighton Health Commercial |
$19.09
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.18
|
| Rate for Payer: Healthfirst QHP |
$10.18
|
| Rate for Payer: Humana Medicare |
$10.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare Commercial |
$12.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.14
|
| Rate for Payer: Wellcare Medicare |
$9.16
|
|
|
E. CHAFFEENSIS-HME (MONOCYCTIC)
|
Facility
|
IP
|
$25.45
|
|
|
Service Code
|
HCPCS 86666
|
| Hospital Charge Code |
40729361
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$10.18
|
|
