|
ECHCARDIOGRAPH TRANSTHORACIC
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
30105304
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$446.58 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$1,093.94
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$637.97
|
| Rate for Payer: Group Health Inc Medicare |
$637.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
ECHCARDIOGRAPH TRANSTHORACIC
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
30105304
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
ECHINOCOCCUS ANTIBODY
|
Facility
|
OP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40729367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.11
|
| Rate for Payer: Brighton Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.01
|
| Rate for Payer: EmblemHealth Commercial |
$13.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.58
|
| Rate for Payer: Group Health Inc Commercial |
$13.01
|
| Rate for Payer: Group Health Inc Medicare |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.01
|
| Rate for Payer: Healthfirst QHP |
$13.01
|
| Rate for Payer: Humana Medicare |
$13.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.41
|
| Rate for Payer: Wellcare Medicare |
$11.71
|
|
|
ECHINOCOCCUS ANTIBODY
|
Facility
|
IP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40729367
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.01
|
|
|
ECHINOCOCCUS GRANULOSUS AB (IGG),
|
Facility
|
OP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40728346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.01
|
| Rate for Payer: Aetna Government |
$13.01
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.11
|
| Rate for Payer: Brighton Health Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.01
|
| Rate for Payer: EmblemHealth Commercial |
$13.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.58
|
| Rate for Payer: Group Health Inc Commercial |
$13.01
|
| Rate for Payer: Group Health Inc Medicare |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.01
|
| Rate for Payer: Healthfirst QHP |
$13.01
|
| Rate for Payer: Humana Medicare |
$13.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.41
|
| Rate for Payer: Wellcare Medicare |
$11.71
|
|
|
ECHINOCOCCUS GRANULOSUS AB (IGG),
|
Facility
|
IP
|
$32.53
|
|
|
Service Code
|
HCPCS 86682
|
| Hospital Charge Code |
40728346
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$13.01
|
|
|
ECHO 2D
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Hospital Charge Code |
30301312
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
ECHO 2D
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Hospital Charge Code |
30301312
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
ECHOCARDIOGRAM-M MODE & 2D
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Hospital Charge Code |
40802000
|
|
Hospital Revenue Code
|
483
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
ECHOCARDIOGRAM-M MODE & 2D
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93307 TC
|
| Hospital Charge Code |
40802000
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report
|
Facility
|
OP
|
$6,937.00
|
|
|
Service Code
|
CPT 93312
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$446.58 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,959.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,215.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$637.97
|
| Rate for Payer: Group Health Inc Medicare |
$637.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
ECHO COLOR FLOW
|
Facility
|
OP
|
$171.78
|
|
|
Service Code
|
HCPCS 93325 TC
|
| Hospital Charge Code |
30301303
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.02
|
| Rate for Payer: Aetna Government |
$20.02
|
| Rate for Payer: Brighton Health Commercial |
$128.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$137.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.81
|
| Rate for Payer: Group Health Inc Commercial |
$85.89
|
| Rate for Payer: Group Health Inc Medicare |
$60.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.89
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
ECHO DOPPLER
|
Facility
|
OP
|
$243.43
|
|
|
Service Code
|
HCPCS 93320 TC
|
| Hospital Charge Code |
30301313
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.10
|
| Rate for Payer: Aetna Government |
$32.10
|
| Rate for Payer: Brighton Health Commercial |
$182.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$194.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.53
|
| Rate for Payer: Group Health Inc Commercial |
$121.72
|
| Rate for Payer: Group Health Inc Medicare |
$85.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.72
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
ECHO EXAMINATION OF EYE
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76516 TC
|
| Hospital Charge Code |
30306404
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
ECHO EXAMINATION OF EYE
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76516 TC
|
| Hospital Charge Code |
30306404
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$186.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$49.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
ECHO EXAM OF EYE
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76519 TC
|
| Hospital Charge Code |
30305684
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
ECHO EXAM OF EYE
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76519 TC
|
| Hospital Charge Code |
30305684
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$192.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
ECHO EXAM OF EYE THICKNESS
|
Facility
|
OP
|
$69.63
|
|
|
Service Code
|
HCPCS 76514 TC
|
| Hospital Charge Code |
30305683
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.43
|
| Rate for Payer: Aetna Government |
$34.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.10
|
| Rate for Payer: Brighton Health Commercial |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Cash Price |
$34.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.43
|
| Rate for Payer: EmblemHealth Commercial |
$24.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.64
|
| Rate for Payer: Group Health Inc Commercial |
$30.99
|
| Rate for Payer: Group Health Inc Medicare |
$30.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$34.43
|
| Rate for Payer: Humana Medicare |
$35.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.43
|
| Rate for Payer: United Healthcare Commercial |
$14.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.54
|
| Rate for Payer: Wellcare Medicare |
$32.71
|
|
|
ECHO EXAM OF EYE THICKNESS
|
Facility
|
IP
|
$69.63
|
|
|
Service Code
|
HCPCS 76514 TC
|
| Hospital Charge Code |
30305683
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$34.43
|
|
|
ECHO EXAM OF HEART
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
30305400
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$198.36 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.36
|
| Rate for Payer: Brighton Health Commercial |
$529.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$283.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Humana Medicare |
$289.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
ECHO EXAM OF HEART
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93308 TC
|
| Hospital Charge Code |
30305400
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
ECHO GUIDE FOR BIOPSY
|
Facility
|
OP
|
$1,144.39
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
30301275
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.83 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.83
|
| Rate for Payer: Aetna Government |
$46.83
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
ECHO INTERPRETATION
|
Facility
|
IP
|
$1,488.58
|
|
|
Service Code
|
HCPCS 93303 TC
|
| Hospital Charge Code |
30301299
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
ECHO INTERPRETATION
|
Facility
|
OP
|
$1,488.58
|
|
|
Service Code
|
HCPCS 93303 TC
|
| Hospital Charge Code |
30301299
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$637.97
|
| Rate for Payer: Aetna Government |
$637.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$446.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$446.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$446.58
|
| Rate for Payer: Brighton Health Commercial |
$1,116.44
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,190.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,012.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$637.97
|
| Rate for Payer: EmblemHealth Commercial |
$637.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$542.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.79
|
| Rate for Payer: Group Health Inc Commercial |
$637.97
|
| Rate for Payer: Group Health Inc Medicare |
$637.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$744.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$542.27
|
| Rate for Payer: Healthfirst QHP |
$637.97
|
| Rate for Payer: Humana Medicare |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.97
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$637.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Wellcare Medicare |
$606.07
|
|
|
ECHOTHIOPHATE IODIDE 0.125% OPHTHALMIC S
|
Facility
|
OP
|
$135.00
|
|
| Hospital Charge Code |
41651087
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.50
|
| Rate for Payer: Aetna Government |
$67.50
|
| Rate for Payer: Brighton Health Commercial |
$101.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.80
|
| Rate for Payer: Group Health Inc Commercial |
$67.50
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.75
|
|
