|
HC DIRECT REFER HOSPITAL OBSERVATION
|
Facility
|
IP
|
$1,528.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
762G037901
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$764.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$764.00
|
|
|
HC DISCOGRAPHY LUMBAR SPINE - FL LUMBAR SPINE DISCOGRAM
|
Facility
|
OP
|
$5,207.00
|
|
|
Service Code
|
CPT 72295 TC
|
| Hospital Charge Code |
3207229501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$3,905.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,863.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.10
|
| Rate for Payer: Aetna Government |
$43.10
|
| Rate for Payer: Brighton Health Commercial |
$3,905.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,578.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,012.25
|
| Rate for Payer: EmblemHealth Commercial |
$74.97
|
| Rate for Payer: Group Health Inc Commercial |
$2,603.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,822.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,603.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.97
|
| Rate for Payer: Healthfirst Essential Plan |
$188.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$83.74
|
|
|
HC DISCOGRAPHY LUMBAR SPINE - FL LUMBAR SPINE DISCOGRAM
|
Facility
|
IP
|
$5,207.00
|
|
|
Service Code
|
CPT 72295 TC
|
| Hospital Charge Code |
3207229501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,603.50 |
| Max. Negotiated Rate |
$2,603.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.50
|
|
|
HC DIST NEURO PERIPH NERVE
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
5106464001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.70 |
| Max. Negotiated Rate |
$1,142.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| 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 |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| 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 |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC DIST NEURO PERIPH NERVE
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
5106464001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC DNA ANTIBODY, NATV/2 STRAND - ANTI DNA, DOUBLE STRANDED
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
3028622501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.74
|
| Rate for Payer: Aetna Government |
$13.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.62
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.74
|
| Rate for Payer: EmblemHealth Commercial |
$13.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.23
|
| Rate for Payer: Group Health Inc Commercial |
$13.74
|
| Rate for Payer: Group Health Inc Medicare |
$13.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.74
|
| Rate for Payer: Healthfirst QHP |
$13.74
|
| Rate for Payer: Humana Medicare |
$14.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.74
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$12.37
|
|
|
HC DNA ANTIBODY, NATV/2 STRAND - ANTI DNA, DOUBLE STRANDED
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
3028622501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - COMPLETE ECHOCARDIOGRAM EXERCISE
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332536
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.66
|
| Rate for Payer: Aetna Government |
$22.66
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - COMPLETE ECHOCARDIOGRAM EXERCISE
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332536
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - CONGENITAL TTE COMPLETE W/ COLOR
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332517
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.66
|
| Rate for Payer: Aetna Government |
$22.66
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - CONGENITAL TTE COMPLETE W/ COLOR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332517
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - CONGENITAL TTE COMPLETE W/ DOPPLER & CLR
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332519
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.66
|
| Rate for Payer: Aetna Government |
$22.66
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - CONGENITAL TTE COMPLETE W/ DOPPLER & CLR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332519
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - CONGENITAL TTE LIMITED W/ COLOR
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332513
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.66
|
| Rate for Payer: Aetna Government |
$22.66
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - CONGENITAL TTE LIMITED W/ COLOR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332513
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - CONGENITAL TTE LIMITED W DOPPLER & COLOR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332515
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - CONGENITAL TTE LIMITED W DOPPLER & COLOR
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332515
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.66
|
| Rate for Payer: Aetna Government |
$22.66
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - FETAL ECHO COMPLETE W/ COLOR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332523
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - FETAL ECHO COMPLETE W/ COLOR
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332523
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.66
|
| Rate for Payer: Aetna Government |
$22.66
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - FETAL ECHO COMPLETE W/ DOPPLER & COLOR
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332524
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.66
|
| Rate for Payer: Aetna Government |
$22.66
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - FETAL ECHO COMPLETE W/ DOPPLER & COLOR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332524
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - FETAL ECHO F/U OR REPEAT STUDY W/ COLOR
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332521
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.66
|
| Rate for Payer: Aetna Government |
$22.66
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - FETAL ECHO F/U OR REPEAT STUDY W/ COLOR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332521
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - FETAL ECHO FU REPEAT STDY W DPPLR & CLR
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332522
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.66
|
| Rate for Payer: Aetna Government |
$22.66
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: EmblemHealth Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER COLOR FLOW ADD-ON - FETAL ECHO FU REPEAT STDY W DPPLR & CLR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
4839332522
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$85.50 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
|
