|
HC ECHO TRANSESOPHAGEAL - TEE W/ DOPPLER, COLOR & CARDIOVERSION
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
4839331212
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC ECHO TRANSESOPHAGEAL - TEE W/ DOPPLER, COLOR & CARDIOVERSION
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
4839331212
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$262.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC ECHO,TRANSRECTAL - US TRANSRECTAL
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76872 TC
|
| Hospital Charge Code |
4027687201
|
|
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,TRANSRECTAL - US TRANSRECTAL
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76872 TC
|
| Hospital Charge Code |
4027687201
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.84
|
| Rate for Payer: Aetna Government |
$47.84
|
| 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 |
$172.64
|
| 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 |
$172.64
|
| Rate for Payer: Healthfirst Essential Plan |
$235.10
|
| Rate for Payer: United Healthcare Commercial |
$77.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.49
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TRANSTHORACIC ECHO (TTE) LIMITED
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330401
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TRANSTHORACIC ECHO (TTE) LIMITED
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330401
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE COMPLETE
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
4839330302
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$744.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$744.00
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE COMPLETE
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
4839330302
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$246.29 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,116.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,190.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,011.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$246.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE COMPLETE W/ COLOR
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
4839330304
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$744.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$744.00
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE COMPLETE W/ COLOR
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
4839330304
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$246.29 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,116.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,190.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,011.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$246.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE COMPLETE W/ DOPPLER AND COLOR
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
4839330306
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$744.00 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$744.00
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE COMPLETE W/ DOPPLER AND COLOR
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
4839330306
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$246.29 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,116.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,190.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,011.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$246.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE LIMITED
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330402
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE LIMITED
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330402
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE LIMITED W/ COLOR
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330404
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE LIMITED W/ COLOR
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330404
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE LIMITED W/ CONTRAST
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330403
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE LIMITED W/ CONTRAST
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330403
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE LIMITED W/ DOPPLER AND COLOR
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330406
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC ECHO TRANSTHORACIC - CONGENITAL TTE LIMITED W/ DOPPLER AND COLOR
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
4839330406
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC ED & TRAIN, 2-4 PTS
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 98961
|
| Hospital Charge Code |
9429896101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.00
|
|
|
HC ED & TRAIN, 2-4 PTS
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 98961
|
| Hospital Charge Code |
9429896101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.24
|
| Rate for Payer: Aetna Government |
$12.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22.45
|
| Rate for Payer: Amida Care Medicaid |
$22.45
|
| Rate for Payer: Brighton Health Commercial |
$105.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.20
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50.51
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.57
|
| 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 |
$22.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.45
|
| Rate for Payer: Healthfirst Essential Plan |
$50.51
|
| Rate for Payer: Healthfirst QHP |
$36.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.45
|
| Rate for Payer: SOMOS Essential |
$50.51
|
| Rate for Payer: United Healthcare Commercial |
$70.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$24.69
|
| Rate for Payer: United Healthcare Medicaid |
$22.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.45
|
|
|
HC ED & TRAIN 5-8 PTS
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 98962
|
| Hospital Charge Code |
9429896201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.06
|
| Rate for Payer: Aetna Government |
$9.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22.45
|
| Rate for Payer: Amida Care Medicaid |
$22.45
|
| Rate for Payer: Brighton Health Commercial |
$105.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$95.20
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50.51
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.57
|
| 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 |
$22.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.45
|
| Rate for Payer: Healthfirst Essential Plan |
$50.51
|
| Rate for Payer: Healthfirst QHP |
$36.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.45
|
| Rate for Payer: SOMOS Essential |
$50.51
|
| Rate for Payer: United Healthcare Commercial |
$70.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$24.69
|
| Rate for Payer: United Healthcare Medicaid |
$22.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.45
|
|
|
HC ED & TRAIN 5-8 PTS
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 98962
|
| Hospital Charge Code |
9429896201
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.00
|
|
|
HC EEG,COMA/SLEEP RECORD ONLY
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 95822 TC
|
| Hospital Charge Code |
7409582201
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
