|
HC ANGIO EA ADDNL SELECTV VESSEL - IR ANGIO SELECTIVE EA ADDL VESSEL
|
Facility
|
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 75774 TC
|
| Hospital Charge Code |
3237577401
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$52.96 |
| Max. Negotiated Rate |
$2,183.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,500.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.37
|
| Rate for Payer: Aetna Government |
$55.37
|
| Rate for Payer: Brighton Health Commercial |
$2,046.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,183.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,855.72
|
| Rate for Payer: EmblemHealth Commercial |
$52.96
|
| Rate for Payer: Group Health Inc Commercial |
$1,364.50
|
| Rate for Payer: Group Health Inc Medicare |
$955.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,364.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.96
|
| Rate for Payer: Healthfirst Essential Plan |
$232.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$103.37
|
|
|
HC ANGIO EXTERMITY BILAT - IR ANGIOGRAM EXTREMITY BILATERAL
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 75716 TC
|
| Hospital Charge Code |
3237571601
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC ANGIO EXTERMITY BILAT - IR ANGIOGRAM EXTREMITY BILATERAL
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 75716 TC
|
| Hospital Charge Code |
3237571601
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$75.18 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$97.22
|
| Rate for Payer: Aetna Government |
$97.22
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,336.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,650.49
|
| Rate for Payer: EmblemHealth Commercial |
$75.18
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.18
|
| Rate for Payer: Healthfirst Essential Plan |
$392.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$174.26
|
|
|
HC ANGIO EXTREMITY UNILAT - IR ANGIOGRAM EXTREMITY
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 75710 TC
|
| Hospital Charge Code |
3237571001
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC ANGIO EXTREMITY UNILAT - IR ANGIOGRAM EXTREMITY
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 75710 TC
|
| Hospital Charge Code |
3237571001
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$70.98 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.52
|
| Rate for Payer: Aetna Government |
$84.52
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,336.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,650.49
|
| Rate for Payer: EmblemHealth Commercial |
$70.98
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.98
|
| Rate for Payer: Healthfirst Essential Plan |
$339.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$150.76
|
|
|
HC ANGIOGRAPHY, PULMONARY, NONSELECTIVE CATH OR VENOUS INJ
|
Facility
|
IP
|
$4,940.00
|
|
|
Service Code
|
CPT 75746 TC
|
| Hospital Charge Code |
3207574601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
|
|
HC ANGIOGRAPHY, PULMONARY, NONSELECTIVE CATH OR VENOUS INJ
|
Facility
|
OP
|
$4,940.00
|
|
|
Service Code
|
CPT 75746 TC
|
| Hospital Charge Code |
3207574601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$3,705.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,717.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.60
|
| Rate for Payer: Aetna Government |
$75.60
|
| Rate for Payer: Brighton Health Commercial |
$3,705.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,538.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,294.59
|
| Rate for Payer: EmblemHealth Commercial |
$87.75
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.75
|
| Rate for Payer: Healthfirst Essential Plan |
$687.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$305.77
|
|
|
HC ANGIO INTERN MAMMARY - IR ANGIOGRAM INTERNAL MAMMARY
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 75756 TC
|
| Hospital Charge Code |
3237575601
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$87.59 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.59
|
| Rate for Payer: Aetna Government |
$87.59
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,538.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,294.59
|
| Rate for Payer: EmblemHealth Commercial |
$113.81
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.81
|
| Rate for Payer: Healthfirst Essential Plan |
$350.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$155.84
|
|
|
HC ANGIO INTERN MAMMARY - IR ANGIOGRAM INTERNAL MAMMARY
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 75756 TC
|
| Hospital Charge Code |
3237575601
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC ANGIO PELVIS - IR ANGIO PELVIC SELECTIVE OR SUPRASELECTIVE
|
Facility
|
OP
|
$13,920.00
|
|
|
Service Code
|
CPT 75736 TC
|
| Hospital Charge Code |
3237573601
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$10,440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,656.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.13
|
| Rate for Payer: Aetna Government |
$83.13
|
| Rate for Payer: Brighton Health Commercial |
$10,440.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,336.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,650.49
|
| Rate for Payer: EmblemHealth Commercial |
$98.43
|
| Rate for Payer: Group Health Inc Commercial |
$6,960.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,872.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,960.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.43
|
| Rate for Payer: Healthfirst Essential Plan |
$701.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$311.65
|
|
|
HC ANGIO PELVIS - IR ANGIO PELVIC SELECTIVE OR SUPRASELECTIVE
|
Facility
|
IP
|
$13,920.00
|
|
|
Service Code
|
CPT 75736 TC
|
| Hospital Charge Code |
3237573601
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$6,960.00 |
| Max. Negotiated Rate |
$6,960.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
|
|
HC ANGIO PULMON BILAT SELECT - IR ANGIOGRAM PULMONARY SELECTIVE BILAT
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 75743 TC
|
| Hospital Charge Code |
3237574302
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC ANGIO PULMON BILAT SELECT - IR ANGIOGRAM PULMONARY SELECTIVE BILAT
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 75743 TC
|
| Hospital Charge Code |
3237574302
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.88
|
| Rate for Payer: Aetna Government |
$69.88
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,336.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,650.49
|
| Rate for Payer: EmblemHealth Commercial |
$75.18
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.18
|
| Rate for Payer: Healthfirst Essential Plan |
$726.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$322.90
|
|
|
HC ANGIO PULMON UNILAT SELECT - IR ANGIOGRAM PULMONARY SELECTIVE
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 75741 TC
|
| Hospital Charge Code |
3237574101
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$69.04 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.04
|
| Rate for Payer: Aetna Government |
$69.04
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,336.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,650.49
|
| Rate for Payer: EmblemHealth Commercial |
$73.77
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,196.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.77
|
| Rate for Payer: Healthfirst Essential Plan |
$688.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$305.78
|
|
|
HC ANGIO PULMON UNILAT SELECT - IR ANGIOGRAM PULMONARY SELECTIVE
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 75741 TC
|
| Hospital Charge Code |
3237574101
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC ANGIO SPINAL SELECTV - IR ANGIOGRAM SPINAL SELECTIVE
|
Facility
|
OP
|
$13,920.00
|
|
|
Service Code
|
CPT 75705 TC
|
| Hospital Charge Code |
3237570501
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$10,440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,656.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$101.82
|
| Rate for Payer: Aetna Government |
$101.82
|
| Rate for Payer: Brighton Health Commercial |
$10,440.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,336.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,650.49
|
| Rate for Payer: EmblemHealth Commercial |
$147.00
|
| Rate for Payer: Group Health Inc Commercial |
$6,960.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,872.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,960.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.00
|
| Rate for Payer: Healthfirst Essential Plan |
$787.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$350.18
|
|
|
HC ANGIO SPINAL SELECTV - IR ANGIOGRAM SPINAL SELECTIVE
|
Facility
|
IP
|
$13,920.00
|
|
|
Service Code
|
CPT 75705 TC
|
| Hospital Charge Code |
3237570501
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$6,960.00 |
| Max. Negotiated Rate |
$6,960.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
|
|
HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERT ENZYME CSF
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3018216402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERT ENZYME CSF
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3018216402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.60
|
| Rate for Payer: Aetna Government |
$14.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.22
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.60
|
| Rate for Payer: EmblemHealth Commercial |
$14.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.99
|
| Rate for Payer: Group Health Inc Commercial |
$14.60
|
| Rate for Payer: Group Health Inc Medicare |
$14.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.60
|
| Rate for Payer: Healthfirst QHP |
$14.60
|
| Rate for Payer: Humana Medicare |
$14.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.60
|
| Rate for Payer: United Healthcare Commercial |
$18.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.87
|
| Rate for Payer: Wellcare Medicare |
$13.14
|
|
|
HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3018216401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3018216401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.60
|
| Rate for Payer: Aetna Government |
$14.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.22
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.60
|
| Rate for Payer: EmblemHealth Commercial |
$14.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.99
|
| Rate for Payer: Group Health Inc Commercial |
$14.60
|
| Rate for Payer: Group Health Inc Medicare |
$14.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.60
|
| Rate for Payer: Healthfirst QHP |
$14.60
|
| Rate for Payer: Humana Medicare |
$14.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.60
|
| Rate for Payer: United Healthcare Commercial |
$18.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.87
|
| Rate for Payer: Wellcare Medicare |
$13.14
|
|
|
HC ANGIO VISCERAL SELECTV/SUBSELEC - IR ANGIO VISCERAL SELECTIVE
|
Facility
|
IP
|
$13,920.00
|
|
|
Service Code
|
CPT 75726 TC
|
| Hospital Charge Code |
3237572601
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$6,960.00 |
| Max. Negotiated Rate |
$6,960.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
|
|
HC ANGIO VISCERAL SELECTV/SUBSELEC - IR ANGIO VISCERAL SELECTIVE
|
Facility
|
OP
|
$13,920.00
|
|
|
Service Code
|
CPT 75726 TC
|
| Hospital Charge Code |
3237572601
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$74.06 |
| Max. Negotiated Rate |
$10,440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,656.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.06
|
| Rate for Payer: Aetna Government |
$74.06
|
| Rate for Payer: Brighton Health Commercial |
$10,440.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,336.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,650.49
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Commercial |
$6,960.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,872.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,960.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.46
|
| Rate for Payer: Healthfirst Essential Plan |
$336.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.58
|
|
|
HC ANOSCOPY AND BIOPSY - ENDOSCOPY, ANUS
|
Facility
|
OP
|
$3,041.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
3614660601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.09 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,440.62
|
| Rate for Payer: Aetna Government |
$1,440.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,008.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,008.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,008.43
|
| Rate for Payer: Brighton Health Commercial |
$2,280.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,440.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,440.62
|
| Rate for Payer: EmblemHealth Commercial |
$1,440.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,296.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,224.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,282.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,440.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,282.15
|
| Rate for Payer: Group Health Inc Commercial |
$1,440.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$218.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,224.53
|
| Rate for Payer: Healthfirst QHP |
$1,440.62
|
| Rate for Payer: Humana Medicare |
$1,469.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,440.62
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,440.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,440.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,368.59
|
| Rate for Payer: Wellcare Medicare |
$1,368.59
|
|
|
HC ANOSCOPY AND BIOPSY - ENDOSCOPY, ANUS
|
Facility
|
IP
|
$3,041.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
3614660601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,520.50 |
| Max. Negotiated Rate |
$1,520.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.50
|
|
