|
EPV CARDIAC STRESS
|
Facility
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 93017 TC
|
| Hospital Charge Code |
66574555
|
|
Hospital Revenue Code
|
482
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
EPV CARDIOVER ELEV ELECT
|
Facility
|
OP
|
$1,624.80
|
|
|
Service Code
|
HCPCS 92960 TC
|
| Hospital Charge Code |
66574552
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$526.84 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$893.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$752.63
|
| Rate for Payer: Aetna Government |
$752.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$526.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$526.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$526.84
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cash Price |
$752.63
|
| Rate for Payer: Cash Price |
$752.63
|
| Rate for Payer: Cash Price |
$752.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$752.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,959.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,215.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$752.63
|
| Rate for Payer: EmblemHealth Commercial |
$752.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$639.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$669.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$752.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$669.84
|
| Rate for Payer: Group Health Inc Commercial |
$752.63
|
| Rate for Payer: Group Health Inc Medicare |
$752.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$812.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$752.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$639.74
|
| Rate for Payer: Healthfirst QHP |
$752.63
|
| Rate for Payer: Humana Medicare |
$767.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$752.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$752.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$752.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$602.10
|
| Rate for Payer: Wellcare Medicare |
$715.00
|
|
|
EPV CARDIOVER ELEV ELECT
|
Facility
|
IP
|
$1,624.80
|
|
|
Service Code
|
HCPCS 92960 TC
|
| Hospital Charge Code |
66574552
|
|
Hospital Revenue Code
|
481
|
| Rate for Payer: Cash Price |
$752.63
|
|
|
EPV CAROTID DUPLEX
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93880 TC
|
| Hospital Charge Code |
66574597
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
EPV CAROTID DUPLEX
|
Facility
|
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 93880 TC
|
| Hospital Charge Code |
66574597
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| 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 |
$94.00
|
| 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
|
|
|
EPV CATH ABLATION TRET PVI
|
Facility
|
IP
|
$61,893.33
|
|
|
Service Code
|
HCPCS 93656 TC
|
| Hospital Charge Code |
66574591
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$27,465.50
|
|
|
EPV CATH ABLATION TRET PVI
|
Facility
|
OP
|
$61,893.33
|
|
|
Service Code
|
HCPCS 93656 TC
|
| Hospital Charge Code |
66574591
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$49,514.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34,041.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,465.50
|
| Rate for Payer: Aetna Government |
$27,465.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19,225.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19,225.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,225.85
|
| Rate for Payer: Brighton Health Commercial |
$46,420.00
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$27,465.50
|
| Rate for Payer: EmblemHealth Commercial |
$27,465.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23,345.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24,444.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,465.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,444.30
|
| Rate for Payer: Group Health Inc Commercial |
$27,465.50
|
| Rate for Payer: Group Health Inc Medicare |
$27,465.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,946.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,465.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,345.68
|
| Rate for Payer: Healthfirst QHP |
$27,465.50
|
| Rate for Payer: Humana Medicare |
$28,014.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,465.50
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,465.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,465.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,972.40
|
| Rate for Payer: Wellcare Medicare |
$26,092.22
|
|
|
EPV CATH ABLATION TRET SVT
|
Facility
|
OP
|
$61,893.33
|
|
|
Service Code
|
HCPCS 93653 TC
|
| Hospital Charge Code |
66574588
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$49,514.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34,041.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,465.50
|
| Rate for Payer: Aetna Government |
$27,465.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19,225.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19,225.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,225.85
|
| Rate for Payer: Brighton Health Commercial |
$46,420.00
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$27,465.50
|
| Rate for Payer: EmblemHealth Commercial |
$27,465.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23,345.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24,444.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,465.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,444.30
|
| Rate for Payer: Group Health Inc Commercial |
$27,465.50
|
| Rate for Payer: Group Health Inc Medicare |
$27,465.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,946.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,465.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,345.68
|
| Rate for Payer: Healthfirst QHP |
$27,465.50
|
| Rate for Payer: Humana Medicare |
$28,014.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,465.50
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,465.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,465.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,972.40
|
| Rate for Payer: Wellcare Medicare |
$26,092.22
|
|
|
EPV CATH ABLATION TRET SVT
|
Facility
|
IP
|
$61,893.33
|
|
|
Service Code
|
HCPCS 93653 TC
|
| Hospital Charge Code |
66574588
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$27,465.50
|
|
|
EPV CATH ABLATION TRET VT
|
Facility
|
IP
|
$61,893.33
|
|
|
Service Code
|
HCPCS 93654 TC
|
| Hospital Charge Code |
66574589
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$27,465.50
|
|
|
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 |
$316.00 |
| Max. Negotiated Rate |
$49,514.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34,041.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,465.50
|
| Rate for Payer: Aetna Government |
$27,465.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19,225.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19,225.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,225.85
|
| Rate for Payer: Brighton Health Commercial |
$46,420.00
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Cash Price |
$27,465.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$27,465.50
|
| Rate for Payer: EmblemHealth Commercial |
$27,465.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23,345.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24,444.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,465.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,444.30
|
| Rate for Payer: Group Health Inc Commercial |
$27,465.50
|
| Rate for Payer: Group Health Inc Medicare |
$27,465.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30,946.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,465.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,345.68
|
| Rate for Payer: Healthfirst QHP |
$27,465.50
|
| Rate for Payer: Humana Medicare |
$28,014.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,465.50
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,465.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,465.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,972.40
|
| Rate for Payer: Wellcare Medicare |
$26,092.22
|
|
|
EPV CATH MAPPING
|
Facility
|
OP
|
$1,153.50
|
|
|
Service Code
|
HCPCS 93609 TC
|
| Hospital Charge Code |
66574576
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$922.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$634.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$101.76
|
| Rate for Payer: Aetna Government |
$101.76
|
| Rate for Payer: Brighton Health Commercial |
$865.12
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
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 |
$198.36 |
| Max. Negotiated Rate |
$564.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$388.21
|
| 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: 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 |
$352.92
|
| 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
|
|
|
EPV COM BILAT EXTREM VEINS
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Hospital Charge Code |
66574603
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
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 |
$53.74 |
| Max. Negotiated Rate |
$1,914.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,316.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.74
|
| Rate for Payer: Aetna Government |
$53.74
|
| Rate for Payer: Brighton Health Commercial |
$1,794.80
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
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 |
$36.89 |
| Max. Negotiated Rate |
$4,590.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,155.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.89
|
| Rate for Payer: Aetna Government |
$36.89
|
| Rate for Payer: Brighton Health Commercial |
$4,303.25
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
EPV COM EPS IND OR ATTMPT
|
Facility
|
IP
|
$17,826.35
|
|
|
Service Code
|
HCPCS 93620 TC
|
| Hospital Charge Code |
66574580
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$8,636.37
|
|
|
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 |
$316.00 |
| Max. Negotiated Rate |
$14,261.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,636.37
|
| Rate for Payer: Aetna Government |
$8,636.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,045.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,045.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,045.46
|
| Rate for Payer: Brighton Health Commercial |
$13,369.76
|
| Rate for Payer: Cash Price |
$8,636.37
|
| Rate for Payer: Cash Price |
$8,636.37
|
| Rate for Payer: Cash Price |
$8,636.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$8,636.37
|
| Rate for Payer: EmblemHealth Commercial |
$8,636.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,340.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,686.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,636.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,686.37
|
| Rate for Payer: Group Health Inc Commercial |
$8,636.37
|
| Rate for Payer: Group Health Inc Medicare |
$8,636.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,913.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,636.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,340.91
|
| Rate for Payer: Healthfirst QHP |
$8,636.37
|
| Rate for Payer: Humana Medicare |
$8,809.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,636.37
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,636.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,636.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,909.10
|
| Rate for Payer: Wellcare Medicare |
$8,204.55
|
|
|
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 |
$316.00 |
| Max. Negotiated Rate |
$14,261.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,804.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,636.37
|
| Rate for Payer: Aetna Government |
$8,636.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,045.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,045.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,045.46
|
| Rate for Payer: Brighton Health Commercial |
$13,369.76
|
| Rate for Payer: Cash Price |
$8,636.37
|
| Rate for Payer: Cash Price |
$8,636.37
|
| Rate for Payer: Cash Price |
$8,636.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$8,636.37
|
| Rate for Payer: EmblemHealth Commercial |
$8,636.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,340.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,686.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,636.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,686.37
|
| Rate for Payer: Group Health Inc Commercial |
$8,636.37
|
| Rate for Payer: Group Health Inc Medicare |
$8,636.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,913.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,636.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,340.91
|
| Rate for Payer: Healthfirst QHP |
$8,636.37
|
| Rate for Payer: Humana Medicare |
$8,809.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,636.37
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,636.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,636.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,909.10
|
| Rate for Payer: Wellcare Medicare |
$8,204.55
|
|
|
EPV COMP EPS W/O INDUCT
|
Facility
|
IP
|
$17,826.35
|
|
|
Service Code
|
HCPCS 93619 TC
|
| Hospital Charge Code |
66574579
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$8,636.37
|
|
|
EPV COMPLETE ECHO
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
66574572
|
|
Hospital Revenue Code
|
731
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
EPV COMPLETE ECHO
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93306 TC
|
| Hospital Charge Code |
66574572
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$253.00 |
| 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 |
$253.00
|
| 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
|
|
|
EPV COM UNILAT EXTREM VEIN
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Hospital Charge Code |
66574604
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
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 |
$89.00 |
| Max. Negotiated Rate |
$271.56 |
| 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 |
$254.59
|
| 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 |
$271.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$127.14
|
| 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 |
$127.14
|
| Rate for Payer: Group Health Inc Medicare |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.07
|
| 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 |
$169.72
|
| 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
|
|
|
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 |
$316.00 |
| Max. Negotiated Rate |
$2,392.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,645.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,376.30
|
| Rate for Payer: Aetna Government |
$1,376.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$963.41
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$963.41
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$963.41
|
| Rate for Payer: Brighton Health Commercial |
$2,243.31
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Cash Price |
$1,376.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$1,376.30
|
| Rate for Payer: EmblemHealth Commercial |
$1,376.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,169.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,224.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,376.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,224.91
|
| Rate for Payer: Group Health Inc Commercial |
$1,376.30
|
| Rate for Payer: Group Health Inc Medicare |
$1,376.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,495.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,376.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,169.86
|
| Rate for Payer: Healthfirst QHP |
$1,376.30
|
| Rate for Payer: Humana Medicare |
$1,403.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,376.30
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,376.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,376.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,101.04
|
| Rate for Payer: Wellcare Medicare |
$1,307.48
|
|
