|
HC CATARACT SURG W/IOL 1 STAGE
|
Facility
|
OP
|
$6,123.00
|
|
|
Service Code
|
CPT 66984
|
| Hospital Charge Code |
5106698401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,786.64
|
| Rate for Payer: Aetna Government |
$2,786.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,950.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,950.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,950.65
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,786.64
|
| 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 |
$2,786.64
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,507.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,368.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,480.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,786.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,480.11
|
| 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 |
$2,786.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$606.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,368.64
|
| Rate for Payer: Healthfirst QHP |
$2,786.64
|
| Rate for Payer: Humana Medicare |
$2,842.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,925.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,786.64
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,786.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,786.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,647.31
|
| Rate for Payer: Wellcare Medicare |
$2,647.31
|
|
|
HC CATARACT SURG W/IOL 1 STAGE
|
Facility
|
IP
|
$6,123.00
|
|
|
Service Code
|
CPT 66984
|
| Hospital Charge Code |
5106698401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,061.50 |
| Max. Negotiated Rate |
$3,061.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.50
|
|
|
HC CATH BIOPSY OF HEART LINING
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
4819350501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC CATH BIOPSY OF HEART LINING
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
4819350501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$720.21 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,616.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,845.68
|
| Rate for Payer: Aetna Government |
$3,845.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,691.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,691.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,691.98
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,845.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,845.68
|
| Rate for Payer: EmblemHealth Commercial |
$3,845.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,461.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,268.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,422.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,845.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,422.66
|
| Rate for Payer: Group Health Inc Commercial |
$3,845.68
|
| Rate for Payer: Group Health Inc Medicare |
$3,845.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,845.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,845.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$720.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,268.83
|
| Rate for Payer: Healthfirst QHP |
$3,845.68
|
| Rate for Payer: Humana Medicare |
$3,922.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,845.68
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,845.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,845.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,653.40
|
| Rate for Payer: Wellcare Medicare |
$3,653.40
|
|
|
HC CATH CARDIOVASCULAR PROCEDURE UNLISTED
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
4819379901
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$133.82 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC CATH CARDIOVASCULAR PROCEDURE UNLISTED
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
4819379901
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC CATH CATH PLACE/COR ANG,IMG SUPR/INTRP,BYPASS ANG, R&L CATH, L HRT VENTRIC
|
Facility
|
OP
|
$8,631.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
4819346101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,523.65 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,929.87
|
| Rate for Payer: Aetna Government |
$3,929.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,750.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,750.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,750.91
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,929.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,929.87
|
| Rate for Payer: EmblemHealth Commercial |
$3,929.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,536.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,340.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,497.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,929.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,497.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,929.87
|
| Rate for Payer: Group Health Inc Medicare |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,523.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,340.39
|
| Rate for Payer: Healthfirst QHP |
$3,929.87
|
| Rate for Payer: Humana Medicare |
$4,008.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,929.87
|
| Rate for Payer: United Healthcare Commercial |
$3,955.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,929.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,929.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,733.38
|
| Rate for Payer: Wellcare Medicare |
$3,733.38
|
|
|
HC CATH CATH PLACE/COR ANG,IMG SUPR/INTRP,BYPASS ANG, R&L CATH, L HRT VENTRIC
|
Facility
|
IP
|
$8,631.00
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
4819346101
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,315.50 |
| Max. Negotiated Rate |
$4,315.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.50
|
|
|
HC CATH CATH PLACE/CORON ANGIO, IMG SUPER/INTERP, BYPASS ANGIO,W R HEART CATH
|
Facility
|
OP
|
$8,631.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
4819345701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,363.73 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,929.87
|
| Rate for Payer: Aetna Government |
$3,929.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,750.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,750.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,750.91
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,929.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,929.87
|
| Rate for Payer: EmblemHealth Commercial |
$3,929.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,536.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,340.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,497.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,929.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,497.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,929.87
|
| Rate for Payer: Group Health Inc Medicare |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,363.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,340.39
|
| Rate for Payer: Healthfirst QHP |
$3,929.87
|
| Rate for Payer: Humana Medicare |
$4,008.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,929.87
|
| Rate for Payer: United Healthcare Commercial |
$3,955.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,929.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,929.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,733.38
|
| Rate for Payer: Wellcare Medicare |
$3,733.38
|
|
|
HC CATH CATH PLACE/CORON ANGIO, IMG SUPER/INTERP, BYPASS ANGIO,W R HEART CATH
|
Facility
|
IP
|
$8,631.00
|
|
|
Service Code
|
CPT 93457
|
| Hospital Charge Code |
4819345701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,315.50 |
| Max. Negotiated Rate |
$4,315.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.50
|
|
|
HC CATH CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,R&L HRT CATH, L HRT VENTRIC
|
Facility
|
IP
|
$8,631.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
4819346001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,315.50 |
| Max. Negotiated Rate |
$4,315.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.50
|
|
|
HC CATH CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,R&L HRT CATH, L HRT VENTRIC
|
Facility
|
OP
|
$8,631.00
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
4819346001
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,381.25 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,929.87
|
| Rate for Payer: Aetna Government |
$3,929.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,750.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,750.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,750.91
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,929.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,929.87
|
| Rate for Payer: EmblemHealth Commercial |
$3,929.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,536.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,340.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,497.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,929.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,497.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,929.87
|
| Rate for Payer: Group Health Inc Medicare |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,381.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,340.39
|
| Rate for Payer: Healthfirst QHP |
$3,929.87
|
| Rate for Payer: Humana Medicare |
$4,008.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,929.87
|
| Rate for Payer: United Healthcare Commercial |
$3,955.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,929.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,929.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,733.38
|
| Rate for Payer: Wellcare Medicare |
$3,733.38
|
|
|
HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP
|
Facility
|
IP
|
$8,631.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
4819345401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,315.50 |
| Max. Negotiated Rate |
$4,315.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.50
|
|
|
HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP
|
Facility
|
OP
|
$8,631.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
4819345401
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,003.41 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,929.87
|
| Rate for Payer: Aetna Government |
$3,929.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,750.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,750.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,750.91
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,929.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,929.87
|
| Rate for Payer: EmblemHealth Commercial |
$3,929.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,536.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,340.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,497.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,929.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,497.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,929.87
|
| Rate for Payer: Group Health Inc Medicare |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,003.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,340.39
|
| Rate for Payer: Healthfirst QHP |
$3,929.87
|
| Rate for Payer: Humana Medicare |
$4,008.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,929.87
|
| Rate for Payer: United Healthcare Commercial |
$3,955.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,929.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,929.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,733.38
|
| Rate for Payer: Wellcare Medicare |
$3,733.38
|
|
|
HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP, BYPASS ANGIO
|
Facility
|
OP
|
$8,631.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
4819345501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,120.65 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,929.87
|
| Rate for Payer: Aetna Government |
$3,929.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,750.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,750.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,750.91
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,929.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,929.87
|
| Rate for Payer: EmblemHealth Commercial |
$3,929.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,536.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,340.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,497.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,929.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,497.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,929.87
|
| Rate for Payer: Group Health Inc Medicare |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,120.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,340.39
|
| Rate for Payer: Healthfirst QHP |
$3,929.87
|
| Rate for Payer: Humana Medicare |
$4,008.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,929.87
|
| Rate for Payer: United Healthcare Commercial |
$3,955.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,929.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,929.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,733.38
|
| Rate for Payer: Wellcare Medicare |
$3,733.38
|
|
|
HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP, BYPASS ANGIO
|
Facility
|
IP
|
$8,631.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
4819345501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,315.50 |
| Max. Negotiated Rate |
$4,315.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.50
|
|
|
HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP,W RIGHT HEART CATH
|
Facility
|
IP
|
$8,631.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
4819345601
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,315.50 |
| Max. Negotiated Rate |
$4,315.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.50
|
|
|
HC CATH CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP,W RIGHT HEART CATH
|
Facility
|
OP
|
$8,631.00
|
|
|
Service Code
|
CPT 93456
|
| Hospital Charge Code |
4819345601
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,249.39 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,929.87
|
| Rate for Payer: Aetna Government |
$3,929.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,750.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,750.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,750.91
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,929.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,929.87
|
| Rate for Payer: EmblemHealth Commercial |
$3,929.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,536.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,340.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,497.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,929.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,497.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,929.87
|
| Rate for Payer: Group Health Inc Medicare |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,249.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,340.39
|
| Rate for Payer: Healthfirst QHP |
$3,929.87
|
| Rate for Payer: Humana Medicare |
$4,008.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,929.87
|
| Rate for Payer: United Healthcare Commercial |
$3,955.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,929.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,929.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,733.38
|
| Rate for Payer: Wellcare Medicare |
$3,733.38
|
|
|
HC CATH DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
4813690901
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.50
|
|
|
HC CATH DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
4813690901
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$6,937.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.98
|
| Rate for Payer: Aetna Government |
$192.98
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: EmblemHealth Commercial |
$172.50
|
| Rate for Payer: Group Health Inc Commercial |
$172.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$224.65
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC CATH ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
4839335501
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$194.84 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$194.84
|
| Rate for Payer: Aetna Government |
$194.84
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: EmblemHealth Commercial |
$729.00
|
| Rate for Payer: Group Health Inc Commercial |
$729.00
|
| Rate for Payer: Group Health Inc Medicare |
$510.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$243.42
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC CATH ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93355
|
| Hospital Charge Code |
4839335501
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC CATH ECHO TRANSESOPH, FOR MONITORING
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93318
|
| Hospital Charge Code |
4839331801
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC CATH ECHO TRANSESOPH, FOR MONITORING
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93318
|
| Hospital Charge Code |
4839331801
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$468.94 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC CATH ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Facility
|
OP
|
$34,275.00
|
|
|
Service Code
|
CPT 33952
|
| Hospital Charge Code |
4813395201
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$482.93 |
| Max. Negotiated Rate |
$18,851.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,851.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$482.93
|
| Rate for Payer: Aetna Government |
$482.93
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: EmblemHealth Commercial |
$17,137.50
|
| Rate for Payer: Group Health Inc Commercial |
$17,137.50
|
| Rate for Payer: Group Health Inc Medicare |
$11,996.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17,137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,137.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$491.39
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
