|
HC CAMS TRIAMCINOLONE ACETONIDE INJ
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
636J330101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$56.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.05
|
| Rate for Payer: EmblemHealth Commercial |
$47.00
|
| Rate for Payer: Group Health Inc Commercial |
$47.00
|
| Rate for Payer: Group Health Inc Medicare |
$32.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.10
|
|
|
HC CAMS VITAMIN B12 INJECTION
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
636J342001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.50
|
|
|
HC CAMS VITAMIN B12 INJECTION
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
636J342001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Brighton Health Commercial |
$22.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.27
|
| Rate for Payer: EmblemHealth Commercial |
$18.50
|
| Rate for Payer: Group Health Inc Commercial |
$18.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.05
|
|
|
HC CANTHOTOMY
|
Facility
|
OP
|
$5,861.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
5106771501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$2,992.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,850.46
|
| Rate for Payer: Aetna Government |
$2,850.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,995.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,995.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,995.32
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,850.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,850.46
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,565.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,422.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,536.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,850.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,536.91
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,850.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,026.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,422.89
|
| Rate for Payer: Healthfirst QHP |
$2,850.46
|
| Rate for Payer: Humana Medicare |
$2,907.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,992.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,850.46
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,850.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,850.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,707.94
|
| Rate for Payer: Wellcare Medicare |
$2,707.94
|
|
|
HC CANTHOTOMY
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
5106771501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,930.50 |
| Max. Negotiated Rate |
$2,930.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.50
|
|
|
HC CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
3018237801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.50
|
|
|
HC CARCINOEMBRYONIC ANTIGEN - CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
3018237801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.96
|
| Rate for Payer: Aetna Government |
$18.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.27
|
| Rate for Payer: Brighton Health Commercial |
$35.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.96
|
| Rate for Payer: EmblemHealth Commercial |
$18.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.87
|
| Rate for Payer: Group Health Inc Commercial |
$18.96
|
| Rate for Payer: Group Health Inc Medicare |
$18.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.96
|
| Rate for Payer: Healthfirst Essential Plan |
$42.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.96
|
| Rate for Payer: Healthfirst QHP |
$18.96
|
| Rate for Payer: Humana Medicare |
$19.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$24.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.96
|
| Rate for Payer: Wellcare Medicare |
$17.06
|
|
|
HC CARDIAC MRI FOR MORPH - MRI CARDIAC MORPH & FUNCT WO IV CONT
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 75557 TC
|
| Hospital Charge Code |
6107555701
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$179.97 |
| Max. Negotiated Rate |
$733.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$259.35
|
| Rate for Payer: Aetna Government |
$259.35
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$733.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$617.72
|
| Rate for Payer: EmblemHealth Commercial |
$179.97
|
| Rate for Payer: Group Health Inc Commercial |
$352.50
|
| Rate for Payer: Group Health Inc Medicare |
$246.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.97
|
| Rate for Payer: Healthfirst Essential Plan |
$650.45
|
| Rate for Payer: United Healthcare Commercial |
$274.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$289.09
|
|
|
HC CARDIAC MRI FOR MORPH - MRI CARDIAC MORPH & FUNCT WO IV CONT
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 75557 TC
|
| Hospital Charge Code |
6107555701
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION MULT
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301724
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION MULT
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301724
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$697.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION SING
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301723
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC CARDIAC STRESS TST,TRACING - ADENOSINE W MYOCARDIAL PERFUSION SING
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301723
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$697.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF MULT
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301712
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF MULT
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301712
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$697.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF SING
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301711
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC CARDIAC STRESS TST,TRACING - DIPYRIDAMOLE W MYOCARDIAL PERF SING
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301711
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$697.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC CARDIAC STRESS TST,TRACING - DOBUTAMINE W MYOCARD PERFUSION MULT
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301706
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$697.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC CARDIAC STRESS TST,TRACING - DOBUTAMINE W MYOCARD PERFUSION MULT
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301706
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC CARDIAC STRESS TST,TRACING - DOBUTAMINE W MYOCARD PERFUSION SING
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301705
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC CARDIAC STRESS TST,TRACING - DOBUTAMINE W MYOCARD PERFUSION SING
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301705
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$697.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC CARDIAC STRESS TST,TRACING - ECHOCARDIOGRAM DOBUTAMINE STRESS TEST
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301733
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC CARDIAC STRESS TST,TRACING - ECHOCARDIOGRAM DOBUTAMINE STRESS TEST
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301733
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$697.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC CARDIAC STRESS TST,TRACING - ECHOCARDIOGRAM EXERCISE STRESS TEST
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301734
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$45.10 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$697.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC CARDIAC STRESS TST,TRACING - ECHOCARDIOGRAM EXERCISE STRESS TEST
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
4829301734
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
