|
EPV INTER DVCE WEAR DEFIB
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93292 TC
|
| Hospital Charge Code |
66574567
|
|
Hospital Revenue Code
|
731
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
EPV INTER DVCE WEAR DEFIB
|
Facility
|
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93292 TC
|
| Hospital Charge Code |
66574567
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$253.00 |
| 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 |
$253.00
|
| 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 MUL ICD W/WO PRO
|
Facility
|
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93284 TC
|
| Hospital Charge Code |
66574561
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$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 MUL ICD W/WO PRO
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93284 TC
|
| Hospital Charge Code |
66574561
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
EPV INTER SNG ICD W/WO PRO
|
Facility
|
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93282 TC
|
| Hospital Charge Code |
66574559
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$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 SNG ICD W/WO PRO
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93282 TC
|
| Hospital Charge Code |
66574559
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
EPV INTER TO 90 INTERM ANAL
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93924 TC
|
| Hospital Charge Code |
66574569
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$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 INTER TO 90 INTERM ANAL
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 93924 TC
|
| Hospital Charge Code |
66574569
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
EPV INTER TO 90 TECH REVW
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93296 TC
|
| Hospital Charge Code |
66574570
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
EPV INTER TO 90 TECH REVW
|
Facility
|
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93296 TC
|
| Hospital Charge Code |
66574570
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$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 LE DOPPLER/PVR W/EXC
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 93924 TC
|
| Hospital Charge Code |
66574598
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
EPV LE DOPPLER/PVR W/EXC
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93924 TC
|
| Hospital Charge Code |
66574598
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$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 OTHER MECH ARTIAL FLTER
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 93655 TC
|
| Hospital Charge Code |
66574590
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$939.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$645.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$395.79
|
| Rate for Payer: Aetna Government |
$395.79
|
| Rate for Payer: Brighton Health Commercial |
$880.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$939.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$798.32
|
| Rate for Payer: Group Health Inc Commercial |
$587.00
|
| Rate for Payer: Group Health Inc Medicare |
$410.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$587.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$587.00
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
EPV PROG POST DRUG INFUS
|
Facility
|
OP
|
$2,360.45
|
|
|
Service Code
|
HCPCS 93623 TC
|
| Hospital Charge Code |
66574583
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$1,888.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.93
|
| Rate for Payer: Aetna Government |
$49.93
|
| Rate for Payer: Brighton Health Commercial |
$1,770.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,888.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,605.11
|
| Rate for Payer: Group Health Inc Commercial |
$1,180.22
|
| Rate for Payer: Group Health Inc Medicare |
$826.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.22
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
EPV REPROG IMPLT LOOP REC
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93285 TC
|
| Hospital Charge Code |
66574562
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
EPV REPROG IMPLT LOOP REC
|
Facility
|
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93285 TC
|
| Hospital Charge Code |
66574562
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$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 TEE
|
Facility
|
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Hospital Charge Code |
66574573
|
|
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 |
$1,093.94
|
| 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 |
$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
|
|
|
EPV TEE
|
Facility
|
IP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Hospital Charge Code |
66574573
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$637.97
|
|
|
EPV TILT TABLE
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 93660 TC
|
| Hospital Charge Code |
66574593
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$1,103.10
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
EPV TILT TABLE
|
Facility
|
IP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 93660 TC
|
| Hospital Charge Code |
66574593
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
EPV TRANS RHYTHM STRIP PM
|
Facility
|
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93293 TC
|
| Hospital Charge Code |
66574568
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$253.00 |
| 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 |
$253.00
|
| 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 TRANS RHYTHM STRIP PM
|
Facility
|
IP
|
$109.80
|
|
|
Service Code
|
HCPCS 93293 TC
|
| Hospital Charge Code |
66574568
|
|
Hospital Revenue Code
|
731
|
| Rate for Payer: Cash Price |
$43.61
|
|
|
EPV TRASEPTAL CATH
|
Facility
|
OP
|
$8,094.10
|
|
|
Service Code
|
HCPCS 93462 TC
|
| Hospital Charge Code |
66574575
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$195.09 |
| Max. Negotiated Rate |
$6,475.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$195.09
|
| Rate for Payer: Aetna Government |
$195.09
|
| Rate for Payer: Brighton Health Commercial |
$6,070.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,475.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,503.99
|
| Rate for Payer: Group Health Inc Commercial |
$4,047.05
|
| Rate for Payer: Group Health Inc Medicare |
$2,832.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,047.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,047.05
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
EPV T-WAVE ALTERNANS
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 93025 TC
|
| Hospital Charge Code |
66574556
|
|
Hospital Revenue Code
|
480
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
EPV T-WAVE ALTERNANS
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 93025 TC
|
| Hospital Charge Code |
66574556
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$126.45 |
| 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 |
$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
|
|
