Below are the facility’s standard observation and facility fee charges for each level of service (only one of the following codes beginning with #9928 will be charged per patient visit).
COVID-19 testing charges listed below are for the test only. Other facility and physician fees will apply. The Families First Coronavirus Response Act (FFCRA) prohibits insurance plans or issuers from imposing out of pocket expenses for COVID-19 testing. Depending on your plan, out of pocket fees may apply for a visit where a COVID-19 test is administered and you are treated for symptoms of COVID-19 or another illness. Any patient responsibility (copays, coinsurance, deductibles) collected for a medical visit that your insurer deems to have no patient responsibility under the FFCRA will be returned after the claim is processed by your insurer.
|Facility Level of Service||Facility Fee|
|99281 – Level 1 Emergency||$632.20|
|99282 – Level 2 Emergency||$1,233.38|
|99283 – Level 3 Emergency||$1,997.38|
|99284 – Level 4 Emergency||$2,496.35|
|99285 – Level 5 Emergency||$3,328.47|
|99291 – Critical Care first 30-74 min||$4,004.56|
|99292 – Critical Care additional 30 min||$4,519.44|
|G0378 – Hourly Observation||$1,600.00|
|86769 SARS-COV-2 COVID-19 Antibody||$199.00|
|87635 SARS-COV-2 COVID-19 AMP PRB||$199.00|
|87426 CORONAVIRUS AG IA||$199.00|
|86328 IA NFCT AB SARSCOV2 COVID 19||$199.00|
|U0002 COVID 19 LAB TEST NONCDC||$200.00|