|
HC DX MAMMO INCL CAD UNI - MAMMO BREAST DIAGNOSTIC
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 77065 TC
|
| Hospital Charge Code |
4017706505
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.60
|
| Rate for Payer: Aetna Government |
$74.60
|
| Rate for Payer: Brighton Health Commercial |
$299.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.32
|
| Rate for Payer: EmblemHealth Commercial |
$92.30
|
| Rate for Payer: Group Health Inc Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Medicare |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.30
|
| Rate for Payer: Healthfirst Essential Plan |
$234.09
|
| Rate for Payer: United Healthcare Commercial |
$78.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.04
|
|
|
HC DX MAMMO INCL CAD UNI - MAMMO BREAST DIAGNOSTIC RIGHT
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 77065 TC
|
| Hospital Charge Code |
4017706506
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.60
|
| Rate for Payer: Aetna Government |
$74.60
|
| Rate for Payer: Brighton Health Commercial |
$299.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.32
|
| Rate for Payer: EmblemHealth Commercial |
$92.30
|
| Rate for Payer: Group Health Inc Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Medicare |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.30
|
| Rate for Payer: Healthfirst Essential Plan |
$234.09
|
| Rate for Payer: United Healthcare Commercial |
$78.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.04
|
|
|
HC DX MAMMO INCL CAD UNI - MAMMO BREAST DIAGNOSTIC RIGHT
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 77065 TC
|
| Hospital Charge Code |
4017706506
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
|
|
HC DX MAMMO INCL CAD UNI - MG BREAST LEFT POST BIOPSY CLIP
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 77065 TC
|
| Hospital Charge Code |
4017706504
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
|
|
HC DX MAMMO INCL CAD UNI - MG BREAST LEFT POST BIOPSY CLIP
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 77065 TC
|
| Hospital Charge Code |
4017706504
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.60
|
| Rate for Payer: Aetna Government |
$74.60
|
| Rate for Payer: Brighton Health Commercial |
$299.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.32
|
| Rate for Payer: EmblemHealth Commercial |
$92.30
|
| Rate for Payer: Group Health Inc Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Medicare |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.30
|
| Rate for Payer: Healthfirst Essential Plan |
$234.09
|
| Rate for Payer: United Healthcare Commercial |
$78.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.04
|
|
|
HC DX MAMMO INCL CAD UNI - MG BREAST POST BIOPSY CLIP
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 77065 TC
|
| Hospital Charge Code |
4017706503
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.60
|
| Rate for Payer: Aetna Government |
$74.60
|
| Rate for Payer: Brighton Health Commercial |
$299.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$319.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$271.32
|
| Rate for Payer: EmblemHealth Commercial |
$92.30
|
| Rate for Payer: Group Health Inc Commercial |
$199.50
|
| Rate for Payer: Group Health Inc Medicare |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.30
|
| Rate for Payer: Healthfirst Essential Plan |
$234.09
|
| Rate for Payer: United Healthcare Commercial |
$78.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.04
|
|
|
HC DX MAMMO INCL CAD UNI - MG BREAST POST BIOPSY CLIP
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 77065 TC
|
| Hospital Charge Code |
4017706503
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.50
|
|
|
HC EAR PROTECTOR ATTENUATION MEASURE
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 92596
|
| Hospital Charge Code |
4719259601
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC EAR PROTECTOR ATTENUATION MEASURE
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 92596
|
| Hospital Charge Code |
4719259601
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.96
|
| Rate for Payer: Aetna Government |
$47.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.57
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.96
|
| Rate for Payer: EmblemHealth Commercial |
$47.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.68
|
| Rate for Payer: Group Health Inc Commercial |
$47.96
|
| Rate for Payer: Group Health Inc Medicare |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.77
|
| Rate for Payer: Healthfirst QHP |
$47.96
|
| Rate for Payer: Humana Medicare |
$48.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45.56
|
| Rate for Payer: Wellcare Medicare |
$45.56
|
|
|
HC ECG/MONITORING AND ANALYSIS - CARDIAC EVENT MONITOR
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 93271
|
| Hospital Charge Code |
7319327101
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$78.50 |
| Max. Negotiated Rate |
$274.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.15
|
| Rate for Payer: Aetna Government |
$112.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$78.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$78.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$78.50
|
| Rate for Payer: Brighton Health Commercial |
$257.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$112.15
|
| Rate for Payer: EmblemHealth Commercial |
$112.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.81
|
| Rate for Payer: Group Health Inc Commercial |
$112.15
|
| Rate for Payer: Group Health Inc Medicare |
$112.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.33
|
| Rate for Payer: Healthfirst QHP |
$112.15
|
| Rate for Payer: Humana Medicare |
$114.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.15
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$106.54
|
| Rate for Payer: Wellcare Medicare |
$106.54
|
|
|
HC ECG/MONITORING AND ANALYSIS - CARDIAC EVENT MONITOR
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 93271
|
| Hospital Charge Code |
7319327101
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.50
|
|
|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 24-48 HOUR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
7319322603
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 24-48 HOUR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
7319322603
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$40.21 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 24 HOUR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
7319322601
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$40.21 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 24 HOUR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
7319322601
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 48 HOUR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
7319322602
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$40.21 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 48 HOUR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
7319322602
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC ECG TRACING ONLY W/O INT & REPORT
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
7309304101
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC ECG TRACING ONLY W/O INT & REPORT
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
7309304101
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC ECHO EXAM OF EYE - AXIAL EYE LENGTH - OD - RIGHT EYE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76519 TC
|
| Hospital Charge Code |
4027651906
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC ECHO EXAM OF EYE - AXIAL EYE LENGTH - OD - RIGHT EYE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76519 TC
|
| Hospital Charge Code |
4027651906
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.03 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.70
|
| Rate for Payer: Aetna Government |
$41.70
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.43
|
| Rate for Payer: EmblemHealth Commercial |
$40.03
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.03
|
| Rate for Payer: Healthfirst Essential Plan |
$112.66
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.07
|
|
|
HC ECHO EXAM OF EYE - AXIAL EYE LENGTH - OS - LEFT EYE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76519 TC
|
| Hospital Charge Code |
4027651907
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC ECHO EXAM OF EYE - AXIAL EYE LENGTH - OS - LEFT EYE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76519 TC
|
| Hospital Charge Code |
4027651907
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.03 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.70
|
| Rate for Payer: Aetna Government |
$41.70
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.43
|
| Rate for Payer: EmblemHealth Commercial |
$40.03
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.03
|
| Rate for Payer: Healthfirst Essential Plan |
$112.66
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.07
|
|
|
HC ECHO EXAM OF EYE - AXIAL EYE LENGTH - OU - BOTH EYES
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76519 TC
|
| Hospital Charge Code |
4027651902
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.03 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.70
|
| Rate for Payer: Aetna Government |
$41.70
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.43
|
| Rate for Payer: EmblemHealth Commercial |
$40.03
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.03
|
| Rate for Payer: Healthfirst Essential Plan |
$112.66
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.07
|
|
|
HC ECHO EXAM OF EYE - AXIAL EYE LENGTH - OU - BOTH EYES
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76519 TC
|
| Hospital Charge Code |
4027651902
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
