|
HC DUPLEX EXTREM VENOUS,UNI OR LTD - UPPER EXTREM SUPERFICIAL VEIN MAP
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
9219397107
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC DUPLEX HEMODIALYSIS ACCESS - HEMODIALYSIS ACCESS DUPLEX
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
9219399001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC DUPLEX HEMODIALYSIS ACCESS - HEMODIALYSIS ACCESS DUPLEX
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
9219399001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC DUPLEX LARGE VESSEL(S),LIMITED
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
9219397901
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC DUPLEX LARGE VESSEL(S),LIMITED
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
9219397901
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC DUPLEX LO EXTREM ART BILAT - CV US DOPPLER ARTERIAL LEGS BILATERAL
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
9219392501
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC DUPLEX LO EXTREM ART BILAT - CV US DOPPLER ARTERIAL LEGS BILATERAL
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
9219392501
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.34
|
| Rate for Payer: Aetna Government |
$295.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$206.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$206.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$206.74
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$295.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.85
|
| Rate for Payer: Group Health Inc Commercial |
$295.34
|
| Rate for Payer: Group Health Inc Medicare |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$273.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.04
|
| Rate for Payer: Healthfirst QHP |
$295.34
|
| Rate for Payer: Humana Medicare |
$301.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.34
|
| Rate for Payer: United Healthcare Commercial |
$352.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$280.57
|
| Rate for Payer: Wellcare Medicare |
$280.57
|
|
|
HC DUPLEX LO EXTREM ART BILAT - US LOWER EXTREMITY ARTERIES BILATERAL
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
4029392501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC DUPLEX LO EXTREM ART BILAT - US LOWER EXTREMITY ARTERIES BILATERAL
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
4029392501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.34
|
| Rate for Payer: Aetna Government |
$295.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$206.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$206.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$206.74
|
| Rate for Payer: Brighton Health Commercial |
$295.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$246.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.85
|
| Rate for Payer: Group Health Inc Commercial |
$265.81
|
| Rate for Payer: Group Health Inc Medicare |
$265.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$273.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.04
|
| Rate for Payer: Healthfirst QHP |
$295.34
|
| Rate for Payer: Humana Medicare |
$301.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$280.57
|
| Rate for Payer: Wellcare Medicare |
$280.57
|
|
|
HC DUPLEX LO EXTREM ART UNILAT/LTD - CV US DOPPLER ARTERIAL LEG
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
9219392601
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC DUPLEX LO EXTREM ART UNILAT/LTD - CV US DOPPLER ARTERIAL LEG
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
9219392601
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC DUPLEX LO EXTREM ART UNILAT/LTD - US LOWER EXTREMITY ARTERIES
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
4029392601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC DUPLEX LO EXTREM ART UNILAT/LTD - US LOWER EXTREMITY ARTERIES
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
4029392601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$129.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$147.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$116.94
|
| Rate for Payer: Group Health Inc Medicare |
$116.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID DUPLEX
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
9219388003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID DUPLEX
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
9219388003
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.34
|
| Rate for Payer: Aetna Government |
$295.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$206.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$206.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$206.74
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$295.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.85
|
| Rate for Payer: Group Health Inc Commercial |
$295.34
|
| Rate for Payer: Group Health Inc Medicare |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.04
|
| Rate for Payer: Healthfirst QHP |
$295.34
|
| Rate for Payer: Humana Medicare |
$301.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.34
|
| Rate for Payer: United Healthcare Commercial |
$352.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$280.57
|
| Rate for Payer: Wellcare Medicare |
$280.57
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID ULTRASOUND NEUROLOGY
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
9219388001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.34
|
| Rate for Payer: Aetna Government |
$295.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$206.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$206.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$206.74
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$295.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.85
|
| Rate for Payer: Group Health Inc Commercial |
$295.34
|
| Rate for Payer: Group Health Inc Medicare |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.04
|
| Rate for Payer: Healthfirst QHP |
$295.34
|
| Rate for Payer: Humana Medicare |
$301.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.34
|
| Rate for Payer: United Healthcare Commercial |
$352.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$280.57
|
| Rate for Payer: Wellcare Medicare |
$280.57
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,BILAT - CAROTID ULTRASOUND NEUROLOGY
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
9219388001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,LIMITED - CV US CAROTID
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
9219388201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,LIMITED - CV US CAROTID
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
9219388201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,LIMITED - CV US CAROTID LEFT
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
9219388202
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC DUPLEX SCAN EXTRACRANIAL,LIMITED - CV US CAROTID LEFT
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
9219388202
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC DUP SCAN PREOPERTIVE VESSEL ASSESSMENT - BILAT
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
9219398501
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$346.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.00
|
|
|
HC DUP SCAN PREOPERTIVE VESSEL ASSESSMENT - BILAT
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
9219398501
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$553.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.34
|
| Rate for Payer: Aetna Government |
$295.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$206.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$206.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$206.74
|
| Rate for Payer: Brighton Health Commercial |
$519.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$553.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$470.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$295.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.85
|
| Rate for Payer: Group Health Inc Commercial |
$295.34
|
| Rate for Payer: Group Health Inc Medicare |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$286.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.04
|
| Rate for Payer: Healthfirst QHP |
$295.34
|
| Rate for Payer: Humana Medicare |
$301.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.34
|
| Rate for Payer: United Healthcare Commercial |
$346.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$280.57
|
| Rate for Payer: Wellcare Medicare |
$280.57
|
|
|
HC DUP SCAN PREOPERTIVE VESSEL ASSESSMENT - UNI
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
9219398601
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$346.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$346.00
|
|
|
HC DUP SCAN PREOPERTIVE VESSEL ASSESSMENT - UNI
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
9219398601
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$56.71 |
| Max. Negotiated Rate |
$553.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$519.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$553.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$470.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$346.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
