|
EPV EMS RNS
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 95937 TC
|
| Hospital Charge Code |
66574660
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
EPV EMS RNS
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 95937 TC
|
| Hospital Charge Code |
66574660
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
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 |
$125.13 |
| Max. Negotiated Rate |
$1,544.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,061.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.13
|
| Rate for Payer: Aetna Government |
$125.13
|
| Rate for Payer: Brighton Health Commercial |
$1,447.65
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
EPV EPS VIA ICD OR NIPS
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 93799 TC
|
| Hospital Charge Code |
66574596
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
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 |
$126.45 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$180.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
EPV FLUORO UP TO 1 HOUR
|
Facility
|
IP
|
$705.83
|
|
|
Service Code
|
HCPCS 76000 TC
|
| Hospital Charge Code |
66574550
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$283.37
|
|
|
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 |
$141.40 |
| Max. Negotiated Rate |
$388.21 |
| 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 |
$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 |
$167.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$141.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$198.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.86
|
| 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 |
$255.03
|
| Rate for Payer: Group Health Inc Medicare |
$255.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.37
|
| 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 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 HEMO ACCESS DUPLEX
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93990 TC
|
| Hospital Charge Code |
66574607
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
EPV HEMO ACCESS DUPLEX
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 93990 TC
|
| Hospital Charge Code |
66574607
|
|
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 HOLTER
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 93225 TC
|
| Hospital Charge Code |
66574557
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$264.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$247.67
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$147.72
|
| Rate for Payer: Group Health Inc Medicare |
$147.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
EPV HOLTER
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 93225 TC
|
| Hospital Charge Code |
66574557
|
|
Hospital Revenue Code
|
731
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
EPV ICE
|
Facility
|
OP
|
$435.75
|
|
|
Service Code
|
HCPCS 93662 TC
|
| Hospital Charge Code |
66574594
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$44.04 |
| Max. Negotiated Rate |
$348.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.04
|
| Rate for Payer: Aetna Government |
$44.04
|
| Rate for Payer: Brighton Health Commercial |
$326.81
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
EPV ILIAC UNI/BYPASS GRAPH
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 93979 TC
|
| Hospital Charge Code |
66574606
|
|
Hospital Revenue Code
|
921
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
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 |
$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 INTCARD 3D MAPPING
|
Facility
|
OP
|
$1,095.55
|
|
|
Service Code
|
HCPCS 93613 TC
|
| Hospital Charge Code |
66574577
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$103.77 |
| Max. Negotiated Rate |
$876.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$602.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.77
|
| Rate for Payer: Aetna Government |
$103.77
|
| Rate for Payer: Brighton Health Commercial |
$821.66
|
| 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
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
EPV INT CARDIOVERSION
|
Facility
|
OP
|
$1,624.80
|
|
|
Service Code
|
HCPCS 92961 TC
|
| Hospital Charge Code |
66574553
|
|
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 |
$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 |
$1,218.60
|
| 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 |
$1,299.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,104.86
|
| 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 |
$316.00
|
| 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 INT CARDIOVERSION
|
Facility
|
IP
|
$1,624.80
|
|
|
Service Code
|
HCPCS 92961 TC
|
| Hospital Charge Code |
66574553
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$752.63
|
|
|
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 |
$30.53 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.61
|
| Rate for Payer: Aetna Government |
$43.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30.53
|
| Rate for Payer: Brighton Health Commercial |
$82.35
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$43.61
|
| Rate for Payer: EmblemHealth Commercial |
$43.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.81
|
| Rate for Payer: Group Health Inc Commercial |
$43.61
|
| Rate for Payer: Group Health Inc Medicare |
$43.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.07
|
| Rate for Payer: Healthfirst QHP |
$43.61
|
| Rate for Payer: Humana Medicare |
$44.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.61
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$41.43
|
|
|
EPV INTER DUL ICD W/WO PRO
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93283 TC
|
| Hospital Charge Code |
66574560
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
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 |
$30.53 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.61
|
| Rate for Payer: Aetna Government |
$43.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30.53
|
| Rate for Payer: Brighton Health Commercial |
$82.35
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$43.61
|
| Rate for Payer: EmblemHealth Commercial |
$43.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.81
|
| Rate for Payer: Group Health Inc Commercial |
$43.61
|
| Rate for Payer: Group Health Inc Medicare |
$43.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.07
|
| Rate for Payer: Healthfirst QHP |
$43.61
|
| Rate for Payer: Humana Medicare |
$44.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.61
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$41.43
|
|
|
EPV INTER DVCE IMPLANT CA
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93289 TC
|
| Hospital Charge Code |
66574564
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
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 |
$30.53 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.61
|
| Rate for Payer: Aetna Government |
$43.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30.53
|
| Rate for Payer: Brighton Health Commercial |
$82.35
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$43.61
|
| Rate for Payer: EmblemHealth Commercial |
$43.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.81
|
| Rate for Payer: Group Health Inc Commercial |
$43.61
|
| Rate for Payer: Group Health Inc Medicare |
$43.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.07
|
| Rate for Payer: Healthfirst QHP |
$43.61
|
| Rate for Payer: Humana Medicare |
$44.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.61
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$41.43
|
|
|
EPV INTER DVCE IMPLT CRDIO
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93290 TC
|
| Hospital Charge Code |
66574565
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
EPV INTER DVCE PACEMAKER
|
Facility
|
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93288 TC
|
| Hospital Charge Code |
66574563
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.61
|
| Rate for Payer: Aetna Government |
$43.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$30.53
|
| Rate for Payer: Brighton Health Commercial |
$82.35
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$43.61
|
| Rate for Payer: EmblemHealth Commercial |
$43.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.81
|
| Rate for Payer: Group Health Inc Commercial |
$43.61
|
| Rate for Payer: Group Health Inc Medicare |
$43.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.07
|
| Rate for Payer: Healthfirst QHP |
$43.61
|
| Rate for Payer: Humana Medicare |
$44.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.61
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$41.43
|
|
|
EPV INTER DVCE PACEMAKER
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93288 TC
|
| Hospital Charge Code |
66574563
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
