St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,W LEFT HEART VENTRICULOGRAPHY

Facility

$8,631.00

Service Code	CPT 93458
Hospital Charge Code	4819345801
Hospital Revenue Code	481
Min. Negotiated Rate	$1,156.16
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	$1,156.16
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 PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY

Facility

$31,452.00

Service Code	CPT 92973
Hospital Charge Code	4819297301
Hospital Revenue Code	481
Min. Negotiated Rate	$165.49
Max. Negotiated Rate	$17,298.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17,298.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.49
Rate for Payer: Aetna Government	$165.49
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	$15,726.00
Rate for Payer: Group Health Inc Commercial	$15,726.00
Rate for Payer: Group Health Inc Medicare	$11,008.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,726.00
Rate for Payer: Hamaspik Choice Inc Medicare	$15,726.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$202.37
Rate for Payer: United Healthcare Commercial	$1,113.00

HC CATH PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY

Facility

$31,452.00

Service Code	CPT 92973
Hospital Charge Code	4819297301
Hospital Revenue Code	481
Min. Negotiated Rate	$15,726.00
Max. Negotiated Rate	$15,726.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,726.00

HC CATH PRQ TRLUML CORONARY ANGIO/ATHEREC ADDL ART/BRNCH

Facility

$7,671.00

Service Code	CPT 92925
Hospital Charge Code	4819292501
Hospital Revenue Code	481
Min. Negotiated Rate	$3,835.50
Max. Negotiated Rate	$3,835.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,835.50

HC CATH PRQ TRLUML CORONARY ANGIO/ATHEREC ADDL ART/BRNCH

Facility

$7,671.00

Service Code	CPT 92925
Hospital Charge Code	4819292501
Hospital Revenue Code	481
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,219.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$300.00
Rate for Payer: Aetna Government	$300.00
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	$3,835.50
Rate for Payer: Group Health Inc Commercial	$3,835.50
Rate for Payer: Group Health Inc Medicare	$2,684.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,835.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,835.50
Rate for Payer: United Healthcare Commercial	$3,190.00

HC CATH PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH

Facility

$7,671.00

Service Code	CPT 92924
Hospital Charge Code	4819292401
Hospital Revenue Code	481
Min. Negotiated Rate	$725.60
Max. Negotiated Rate	$14,133.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,219.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13,856.14
Rate for Payer: Aetna Government	$13,856.14
Rate for Payer: Affinity Essential Plan 1&2	$9,699.30
Rate for Payer: Affinity Essential Plan 3&4	$9,699.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$9,699.30
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13,856.14
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	$13,856.14
Rate for Payer: EmblemHealth Commercial	$13,856.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12,470.53
Rate for Payer: Fidelis Essential Plan Aliesa	$11,777.72
Rate for Payer: Fidelis Essential Plan QHP	$12,331.96
Rate for Payer: Fidelis Medicare Advantage	$13,856.14
Rate for Payer: Fidelis Qualified Health Plan	$12,331.96
Rate for Payer: Group Health Inc Commercial	$13,856.14
Rate for Payer: Group Health Inc Medicare	$13,856.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$13,856.14
Rate for Payer: Hamaspik Choice Inc Medicare	$13,856.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$725.60
Rate for Payer: Healthfirst Medicare Advantage	$11,777.72
Rate for Payer: Healthfirst QHP	$13,856.14
Rate for Payer: Humana Medicare	$14,133.26
Rate for Payer: Senior Whole Health Medicare Advantage	$13,856.14
Rate for Payer: United Healthcare Commercial	$3,190.00
Rate for Payer: United Healthcare Medicare Advantage	$13,856.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13,856.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13,163.33
Rate for Payer: Wellcare Medicare	$13,163.33

HC CATH PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH

Facility

$7,671.00

Service Code	CPT 92924
Hospital Charge Code	4819292401
Hospital Revenue Code	481
Min. Negotiated Rate	$3,835.50
Max. Negotiated Rate	$3,835.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,835.50

HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH

Facility

$4,023.00

Service Code	CPT 92921
Hospital Charge Code	4819292101
Hospital Revenue Code	481
Min. Negotiated Rate	$2,011.50
Max. Negotiated Rate	$2,011.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,011.50

HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH

Facility

$4,023.00

Service Code	CPT 92921
Hospital Charge Code	4819292101
Hospital Revenue Code	481
Min. Negotiated Rate	$329.07
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$329.07
Rate for Payer: Aetna Government	$329.07
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	$2,011.50
Rate for Payer: Group Health Inc Commercial	$2,011.50
Rate for Payer: Group Health Inc Medicare	$1,408.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,011.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,011.50
Rate for Payer: United Healthcare Commercial	$2,546.00

HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH

Facility

$15,004.00

Service Code	CPT 92920
Hospital Charge Code	4819292001
Hospital Revenue Code	481
Min. Negotiated Rate	$7,502.00
Max. Negotiated Rate	$7,502.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,502.00

HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH

Facility

$15,004.00

Service Code	CPT 92920
Hospital Charge Code	4819292001
Hospital Revenue Code	481
Min. Negotiated Rate	$609.30
Max. Negotiated Rate	$7,105.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,593.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6,966.23
Rate for Payer: Aetna Government	$6,966.23
Rate for Payer: Affinity Essential Plan 1&2	$4,876.36
Rate for Payer: Affinity Essential Plan 3&4	$4,876.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$4,876.36
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6,966.23
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	$6,966.23
Rate for Payer: EmblemHealth Commercial	$6,966.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6,269.61
Rate for Payer: Fidelis Essential Plan Aliesa	$5,921.30
Rate for Payer: Fidelis Essential Plan QHP	$6,199.94
Rate for Payer: Fidelis Medicare Advantage	$6,966.23
Rate for Payer: Fidelis Qualified Health Plan	$6,199.94
Rate for Payer: Group Health Inc Commercial	$6,966.23
Rate for Payer: Group Health Inc Medicare	$6,966.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,966.23
Rate for Payer: Hamaspik Choice Inc Medicare	$3,628.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$609.30
Rate for Payer: Healthfirst Medicare Advantage	$5,921.30
Rate for Payer: Healthfirst QHP	$6,966.23
Rate for Payer: Humana Medicare	$7,105.55
Rate for Payer: Senior Whole Health Medicare Advantage	$6,966.23
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$6,966.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,966.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,617.92
Rate for Payer: Wellcare Medicare	$6,617.92

HC CATH PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL

Facility

$6,110.00

Service Code	CPT 92938
Hospital Charge Code	4819293801
Hospital Revenue Code	481
Min. Negotiated Rate	$3,055.00
Max. Negotiated Rate	$3,055.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,055.00

HC CATH PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL

Facility

$6,110.00

Service Code	CPT 92938
Hospital Charge Code	4819293801
Hospital Revenue Code	481
Min. Negotiated Rate	$255.83
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$255.83
Rate for Payer: Aetna Government	$255.83
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	$3,055.00
Rate for Payer: Group Health Inc Commercial	$3,055.00
Rate for Payer: Group Health Inc Medicare	$2,138.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,055.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,055.00
Rate for Payer: United Healthcare Commercial	$2,546.00

HC CATH PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL

Facility

$30,010.00

Service Code	CPT 92937
Hospital Charge Code	4819293701
Hospital Revenue Code	481
Min. Negotiated Rate	$676.16
Max. Negotiated Rate	$16,751.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16,751.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13,856.14
Rate for Payer: Aetna Government	$13,856.14
Rate for Payer: Affinity Essential Plan 1&2	$9,699.30
Rate for Payer: Affinity Essential Plan 3&4	$9,699.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$9,699.30
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13,856.14
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	$13,856.14
Rate for Payer: EmblemHealth Commercial	$13,856.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12,470.53
Rate for Payer: Fidelis Essential Plan Aliesa	$11,777.72
Rate for Payer: Fidelis Essential Plan QHP	$12,331.96
Rate for Payer: Fidelis Medicare Advantage	$13,856.14
Rate for Payer: Fidelis Qualified Health Plan	$12,331.96
Rate for Payer: Group Health Inc Commercial	$13,856.14
Rate for Payer: Group Health Inc Medicare	$13,856.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$13,856.14
Rate for Payer: Hamaspik Choice Inc Medicare	$13,856.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$676.16
Rate for Payer: Healthfirst Medicare Advantage	$11,777.72
Rate for Payer: Healthfirst QHP	$13,856.14
Rate for Payer: Humana Medicare	$14,133.26
Rate for Payer: Senior Whole Health Medicare Advantage	$13,856.14
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$13,856.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13,856.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13,163.33
Rate for Payer: Wellcare Medicare	$13,163.33

HC CATH PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL

Facility

$30,010.00

Service Code	CPT 92937
Hospital Charge Code	4819293701
Hospital Revenue Code	481
Min. Negotiated Rate	$15,005.00
Max. Negotiated Rate	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00

HC CATH PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH

Facility

$6,110.00

Service Code	CPT 92934
Hospital Charge Code	4819293401
Hospital Revenue Code	481
Min. Negotiated Rate	$3,055.00
Max. Negotiated Rate	$3,055.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,055.00

HC CATH PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH

Facility

$6,110.00

Service Code	CPT 92934
Hospital Charge Code	4819293401
Hospital Revenue Code	481
Min. Negotiated Rate	$324.86
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$324.86
Rate for Payer: Aetna Government	$324.86
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	$3,055.00
Rate for Payer: Group Health Inc Commercial	$3,055.00
Rate for Payer: Group Health Inc Medicare	$2,138.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,055.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,055.00
Rate for Payer: United Healthcare Commercial	$2,546.00

HC CATH PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH

Facility

$28,363.00

Service Code	CPT 92929
Hospital Charge Code	4819292901
Hospital Revenue Code	481
Min. Negotiated Rate	$384.04
Max. Negotiated Rate	$14,181.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$384.04
Rate for Payer: Aetna Government	$384.04
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	$14,181.50
Rate for Payer: Group Health Inc Commercial	$14,181.50
Rate for Payer: Group Health Inc Medicare	$9,927.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,181.50
Rate for Payer: Hamaspik Choice Inc Medicare	$14,181.50
Rate for Payer: United Healthcare Commercial	$2,546.00

HC CATH PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH

Facility

$28,363.00

Service Code	CPT 92929
Hospital Charge Code	4819292901
Hospital Revenue Code	481
Min. Negotiated Rate	$14,181.50
Max. Negotiated Rate	$14,181.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$14,181.50

HC CATH PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL

Facility

$6,110.00

Service Code	CPT 92944
Hospital Charge Code	4819294401
Hospital Revenue Code	481
Min. Negotiated Rate	$402.11
Max. Negotiated Rate	$6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.11
Rate for Payer: Aetna Government	$402.11
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	$3,055.00
Rate for Payer: Group Health Inc Commercial	$3,055.00
Rate for Payer: Group Health Inc Medicare	$2,138.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,055.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,055.00
Rate for Payer: United Healthcare Commercial	$2,546.00

HC CATH PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL

Facility

$6,110.00

Service Code	CPT 92944
Hospital Charge Code	4819294401
Hospital Revenue Code	481
Min. Negotiated Rate	$3,055.00
Max. Negotiated Rate	$3,055.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,055.00

HC CATH PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL

Facility

$30,010.00

Service Code	CPT 92943
Hospital Charge Code	4819294301
Hospital Revenue Code	481
Min. Negotiated Rate	$15,005.00
Max. Negotiated Rate	$15,005.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$15,005.00

HC CATH PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL

Facility

$30,010.00

Service Code	CPT 92943
Hospital Charge Code	4819294301
Hospital Revenue Code	481
Min. Negotiated Rate	$760.65
Max. Negotiated Rate	$16,751.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16,751.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13,856.14
Rate for Payer: Aetna Government	$13,856.14
Rate for Payer: Affinity Essential Plan 1&2	$9,699.30
Rate for Payer: Affinity Essential Plan 3&4	$9,699.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$9,699.30
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13,856.14
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	$13,856.14
Rate for Payer: EmblemHealth Commercial	$13,856.14
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12,470.53
Rate for Payer: Fidelis Essential Plan Aliesa	$11,777.72
Rate for Payer: Fidelis Essential Plan QHP	$12,331.96
Rate for Payer: Fidelis Medicare Advantage	$13,856.14
Rate for Payer: Fidelis Qualified Health Plan	$12,331.96
Rate for Payer: Group Health Inc Commercial	$13,856.14
Rate for Payer: Group Health Inc Medicare	$13,856.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$13,856.14
Rate for Payer: Hamaspik Choice Inc Medicare	$13,856.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$760.65
Rate for Payer: Healthfirst Medicare Advantage	$11,777.72
Rate for Payer: Healthfirst QHP	$13,856.14
Rate for Payer: Humana Medicare	$14,133.26
Rate for Payer: Senior Whole Health Medicare Advantage	$13,856.14
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$13,856.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13,856.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13,163.33
Rate for Payer: Wellcare Medicare	$13,163.33

HC CATH PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH

Facility

$48,278.00

Service Code	CPT 92933
Hospital Charge Code	4819293301
Hospital Revenue Code	481
Min. Negotiated Rate	$24,139.00
Max. Negotiated Rate	$24,139.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,139.00

HC CATH PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH

Facility

$48,278.00

Service Code	CPT 92933
Hospital Charge Code	4819293301
Hospital Revenue Code	481
Min. Negotiated Rate	$759.96
Max. Negotiated Rate	$22,378.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16,751.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21,939.88
Rate for Payer: Aetna Government	$21,939.88
Rate for Payer: Affinity Essential Plan 1&2	$15,357.92
Rate for Payer: Affinity Essential Plan 3&4	$15,357.92
Rate for Payer: Affinity Medicaid/CHP/HARP	$15,357.92
Rate for Payer: Brighton Health Commercial	$6,937.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$21,939.88
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	$21,939.88
Rate for Payer: EmblemHealth Commercial	$21,939.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,745.89
Rate for Payer: Fidelis Essential Plan Aliesa	$18,648.90
Rate for Payer: Fidelis Essential Plan QHP	$19,526.49
Rate for Payer: Fidelis Medicare Advantage	$21,939.88
Rate for Payer: Fidelis Qualified Health Plan	$19,526.49
Rate for Payer: Group Health Inc Commercial	$21,939.88
Rate for Payer: Group Health Inc Medicare	$21,939.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,939.88
Rate for Payer: Hamaspik Choice Inc Medicare	$21,939.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$759.96
Rate for Payer: Healthfirst Medicare Advantage	$18,648.90
Rate for Payer: Healthfirst QHP	$21,939.88
Rate for Payer: Humana Medicare	$22,378.68
Rate for Payer: Senior Whole Health Medicare Advantage	$21,939.88
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$21,939.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,939.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,842.89
Rate for Payer: Wellcare Medicare	$20,842.89

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