|
HC EP RMV DUAL LEAD AND PG
|
Facility
|
IP
|
$9,037.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
3613323501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,518.50 |
| Max. Negotiated Rate |
$4,518.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,518.50
|
|
|
HC EP RMV DUAL LEAD AND PG
|
Facility
|
OP
|
$9,037.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
3613323501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$739.57 |
| Max. Negotiated Rate |
$6,777.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,446.57
|
| Rate for Payer: Aetna Government |
$4,446.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,112.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,112.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,112.60
|
| Rate for Payer: Brighton Health Commercial |
$6,777.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,446.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,446.57
|
| Rate for Payer: EmblemHealth Commercial |
$4,446.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,001.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,779.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,957.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,446.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,957.45
|
| Rate for Payer: Group Health Inc Commercial |
$4,446.57
|
| Rate for Payer: Group Health Inc Medicare |
$4,446.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,446.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,953.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$739.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,779.58
|
| Rate for Payer: Healthfirst QHP |
$4,446.57
|
| Rate for Payer: Humana Medicare |
$4,535.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,446.57
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,446.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,446.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,224.24
|
| Rate for Payer: Wellcare Medicare |
$4,224.24
|
|
|
HC EP RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
IP
|
$14,070.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
4803327201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,035.00 |
| Max. Negotiated Rate |
$7,035.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,035.00
|
|
|
HC EP RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
OP
|
$14,070.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
4803327201
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$11,256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,446.57
|
| Rate for Payer: Aetna Government |
$4,446.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,112.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,112.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,112.60
|
| Rate for Payer: Brighton Health Commercial |
$10,552.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,446.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,256.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,567.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,446.57
|
| Rate for Payer: EmblemHealth Commercial |
$4,446.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,001.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,779.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,957.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,446.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,957.45
|
| Rate for Payer: Group Health Inc Commercial |
$4,446.57
|
| Rate for Payer: Group Health Inc Medicare |
$4,446.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,446.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,446.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$406.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,779.58
|
| Rate for Payer: Healthfirst QHP |
$4,446.57
|
| Rate for Payer: Humana Medicare |
$4,535.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,446.57
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,446.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,446.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,224.24
|
| Rate for Payer: Wellcare Medicare |
$4,224.24
|
|
|
HC EPSTEIN-BARR ANTIBODY - EPSTEIN-BARR VIRUS EARLY IGG
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
3028666301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC EPSTEIN-BARR ANTIBODY - EPSTEIN-BARR VIRUS EARLY IGG
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
3028666301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$29.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.12
|
| Rate for Payer: Aetna Government |
$13.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.18
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.12
|
| Rate for Payer: EmblemHealth Commercial |
$13.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.68
|
| Rate for Payer: Group Health Inc Commercial |
$13.12
|
| Rate for Payer: Group Health Inc Medicare |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.12
|
| Rate for Payer: Healthfirst Essential Plan |
$29.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.12
|
| Rate for Payer: Healthfirst QHP |
$13.12
|
| Rate for Payer: Humana Medicare |
$13.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.12
|
| Rate for Payer: United Healthcare Commercial |
$16.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.12
|
| Rate for Payer: Wellcare Medicare |
$11.81
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA ANTIBODY PANEL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
3028666503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$40.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.14
|
| Rate for Payer: Aetna Government |
$18.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.70
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.14
|
| Rate for Payer: EmblemHealth Commercial |
$18.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.14
|
| Rate for Payer: Group Health Inc Commercial |
$18.14
|
| Rate for Payer: Group Health Inc Medicare |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.14
|
| Rate for Payer: Healthfirst Essential Plan |
$40.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$18.14
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare Commercial |
$22.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.14
|
| Rate for Payer: Wellcare Medicare |
$16.33
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA ANTIBODY PANEL
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
3028666503
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGG
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
3028666501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGG
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
3028666501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$40.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.14
|
| Rate for Payer: Aetna Government |
$18.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.70
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.14
|
| Rate for Payer: EmblemHealth Commercial |
$18.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.14
|
| Rate for Payer: Group Health Inc Commercial |
$18.14
|
| Rate for Payer: Group Health Inc Medicare |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.14
|
| Rate for Payer: Healthfirst Essential Plan |
$40.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$18.14
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare Commercial |
$22.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.14
|
| Rate for Payer: Wellcare Medicare |
$16.33
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGM
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
3028666502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
|
|
HC EPSTEIN-BARR CAPSID VCA - EPSTEIN-BARR VIRUS VCA, IGM
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
3028666502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.70 |
| Max. Negotiated Rate |
$40.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.14
|
| Rate for Payer: Aetna Government |
$18.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.70
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.14
|
| Rate for Payer: EmblemHealth Commercial |
$18.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.14
|
| Rate for Payer: Group Health Inc Commercial |
$18.14
|
| Rate for Payer: Group Health Inc Medicare |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.14
|
| Rate for Payer: Healthfirst Essential Plan |
$40.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.14
|
| Rate for Payer: Healthfirst QHP |
$18.14
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare Commercial |
$22.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.14
|
| Rate for Payer: Wellcare Medicare |
$16.33
|
|
|
HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
3028666401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
3028666401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$34.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.29
|
| Rate for Payer: Aetna Government |
$15.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.70
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.29
|
| Rate for Payer: EmblemHealth Commercial |
$15.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.61
|
| Rate for Payer: Group Health Inc Commercial |
$15.29
|
| Rate for Payer: Group Health Inc Medicare |
$15.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.29
|
| Rate for Payer: Healthfirst Essential Plan |
$34.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.29
|
| Rate for Payer: Healthfirst QHP |
$15.29
|
| Rate for Payer: Humana Medicare |
$15.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.29
|
| Rate for Payer: United Healthcare Commercial |
$19.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.29
|
| Rate for Payer: Wellcare Medicare |
$13.76
|
|
|
HC EP STIM/PACING HEART POST IV DRUG INFU
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
4809362301
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$196.22 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,298.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$196.22
|
| Rate for Payer: Aetna Government |
$196.22
|
| Rate for Payer: Brighton Health Commercial |
$1,770.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,888.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,604.80
|
| Rate for Payer: EmblemHealth Commercial |
$1,180.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,180.00
|
| Rate for Payer: Group Health Inc Medicare |
$826.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,180.00
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
HC EP STIM/PACING HEART POST IV DRUG INFU
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
4809362301
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,180.00 |
| Max. Negotiated Rate |
$1,180.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,180.00
|
|
|
HC EP TRANSCATH RMVL OF PERM LEADLESS PCMKR
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
4813327501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC EP TRANSCATH RMVL OF PERM LEADLESS PCMKR
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
4813327501
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$586.93 |
| Max. Negotiated Rate |
$44,507.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44,507.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,845.68
|
| Rate for Payer: Aetna Government |
$3,845.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,691.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,691.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,691.98
|
| Rate for Payer: Brighton Health Commercial |
$6,937.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,845.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,261.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,472.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,845.68
|
| Rate for Payer: EmblemHealth Commercial |
$3,845.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,461.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,268.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,422.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,845.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,422.66
|
| Rate for Payer: Group Health Inc Commercial |
$3,845.68
|
| Rate for Payer: Group Health Inc Medicare |
$3,845.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,845.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,452.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$586.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,268.83
|
| Rate for Payer: Healthfirst QHP |
$3,845.68
|
| Rate for Payer: Humana Medicare |
$3,922.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,845.68
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,845.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,845.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,653.40
|
| Rate for Payer: Wellcare Medicare |
$3,653.40
|
|
|
HC EP TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
4809329305
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.56
|
| Rate for Payer: Aetna Government |
$45.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$31.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$31.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.89
|
| Rate for Payer: Brighton Health Commercial |
$81.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$45.56
|
| Rate for Payer: EmblemHealth Commercial |
$45.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.55
|
| Rate for Payer: Group Health Inc Commercial |
$45.56
|
| Rate for Payer: Group Health Inc Medicare |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.73
|
| Rate for Payer: Healthfirst QHP |
$45.56
|
| Rate for Payer: Humana Medicare |
$46.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.56
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.28
|
| Rate for Payer: Wellcare Medicare |
$43.28
|
|
|
HC EP TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
7319329301
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC EP TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
7319329301
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.56
|
| Rate for Payer: Aetna Government |
$45.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$31.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$31.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.89
|
| Rate for Payer: Brighton Health Commercial |
$81.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$45.56
|
| Rate for Payer: EmblemHealth Commercial |
$45.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.55
|
| Rate for Payer: Group Health Inc Commercial |
$45.56
|
| Rate for Payer: Group Health Inc Medicare |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.73
|
| Rate for Payer: Healthfirst QHP |
$45.56
|
| Rate for Payer: Humana Medicare |
$46.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.56
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.28
|
| Rate for Payer: Wellcare Medicare |
$43.28
|
|
|
HC EP TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
4809329305
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC EQ EMER.PROC. SUN/HOL
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 99050 TC
|
| Hospital Charge Code |
4569905001
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.00
|
|
|
HC EQ EMER.PROC. SUN/HOL
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 99050 TC
|
| Hospital Charge Code |
4569905001
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.57
|
| Rate for Payer: Amida Care Medicaid |
$17.57
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$39.52
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$17.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.44
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.57
|
| Rate for Payer: Healthfirst Essential Plan |
$39.52
|
| Rate for Payer: Healthfirst QHP |
$28.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.57
|
| Rate for Payer: SOMOS Essential |
$39.52
|
| Rate for Payer: United Healthcare Commercial |
$50.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$39.52
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$19.32
|
| Rate for Payer: United Healthcare Medicaid |
$17.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.57
|
|
|
HC ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT - ERCP
|
Facility
|
OP
|
$14,479.00
|
|
|
Service Code
|
CPT 43274 TC
|
| Hospital Charge Code |
3614327401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$545.04 |
| Max. Negotiated Rate |
$10,859.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$545.04
|
| Rate for Payer: Aetna Government |
$545.04
|
| Rate for Payer: Brighton Health Commercial |
$10,859.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$7,239.50
|
| Rate for Payer: Group Health Inc Commercial |
$7,239.50
|
| Rate for Payer: Group Health Inc Medicare |
$5,067.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,239.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,554.96
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
