|
HC EXERCISE TEST BRONCHOSPASM W/ECG
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 94617 TC
|
| Hospital Charge Code |
4609461701
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC EXHALED AIR ANALYSIS: O2
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
4609468001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$61.11 |
| Max. Negotiated Rate |
$336.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$315.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$336.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$286.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$210.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC EXHALED AIR ANALYSIS: O2
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 94680
|
| Hospital Charge Code |
4609468001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$210.50 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
|
|
HC EXPLORE/IRRIGATE TEAR DUCTS
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 68840
|
| Hospital Charge Code |
5106884001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$383.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.24
|
| Rate for Payer: Aetna Government |
$365.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$255.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$255.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$255.67
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$365.24
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.06
|
| 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 |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.45
|
| Rate for Payer: Healthfirst QHP |
$365.24
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.24
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$346.98
|
| Rate for Payer: Wellcare Medicare |
$346.98
|
|
|
HC EXPLORE/IRRIGATE TEAR DUCTS
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 68840
|
| Hospital Charge Code |
5106884001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$397.00 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.00
|
|
|
HC EXPLORE PENETRATING WOUND ABDOMEN/FLANK/BACK
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
3612010201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.67 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,234.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC EXPLORE PENETRATING WOUND ABDOMEN/FLANK/BACK
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
3612010201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC EXPLORE PENETRATING WOUND CHEST
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 20101
|
| Hospital Charge Code |
3612010101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC EXPLORE PENETRATING WOUND CHEST
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 20101
|
| Hospital Charge Code |
3612010101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.46 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,234.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$250.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC EXPLORE PENETRATING WOUND EXTREMITY
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
3612010301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.14 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$1,436.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| 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 |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$404.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC EXPLORE PENETRATING WOUND EXTREMITY
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
3612010301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$957.50 |
| Max. Negotiated Rate |
$957.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$957.50
|
|
|
HC EXPLOR POSTOP BLEED,INFEC,CLOT-CHST
|
Facility
|
OP
|
$4,126.00
|
|
|
Service Code
|
CPT 35820
|
| Hospital Charge Code |
3613582001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,444.10 |
| Max. Negotiated Rate |
$3,094.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,269.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,254.32
|
| Rate for Payer: Aetna Government |
$2,254.32
|
| Rate for Payer: Brighton Health Commercial |
$3,094.50
|
| 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 |
$2,063.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,063.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,444.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,063.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,063.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,347.69
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HC EXPLOR POSTOP BLEED,INFEC,CLOT-CHST
|
Facility
|
IP
|
$4,126.00
|
|
|
Service Code
|
CPT 35820
|
| Hospital Charge Code |
3613582001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,063.00 |
| Max. Negotiated Rate |
$2,063.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,063.00
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 24-48 HOUR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
7319322501
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 24-48 HOUR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
7319322501
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 24 HOUR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
7319322502
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 24 HOUR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
7319322502
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 48 HOUR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
7319322503
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 48 HOUR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
7319322503
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC EXTERNAL CEPHALIC VERSION, W OR W/O TOCOLYSIS
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
3615941201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC EXTERNAL CEPHALIC VERSION, W OR W/O TOCOLYSIS
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
3615941201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$5,674.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$79.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35.35
|
| Rate for Payer: Amida Care Medicaid |
$35.35
|
| Rate for Payer: Brighton Health Commercial |
$5,674.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| 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 |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$79.54
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$35.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.12
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,535.00
|
| Rate for Payer: Healthfirst Essential Plan |
$79.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$57.62
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.35
|
| Rate for Payer: SOMOS Essential |
$79.54
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$79.54
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$38.88
|
| Rate for Payer: United Healthcare Medicaid |
$35.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35.35
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC EXTERNAL EKG, UP TO 48HRS, W/REPORT
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
7319322701
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
|
|
HC EXTERNAL EKG, UP TO 48HRS, W/REPORT
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
7319322701
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.52
|
| Rate for Payer: Aetna Government |
$22.52
|
| Rate for Payer: Brighton Health Commercial |
$53.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.28
|
| Rate for Payer: EmblemHealth Commercial |
$35.50
|
| Rate for Payer: Group Health Inc Commercial |
$35.50
|
| Rate for Payer: Group Health Inc Medicare |
$24.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.49
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
|
|
HC EXTERNAL ELECTROCARDIOGRAPHIC RECORD FOR > 48HRS-7DAY
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 93244
|
| Hospital Charge Code |
7319324401
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
|
|
HC EXTERNAL ELECTROCARDIOGRAPHIC RECORD FOR > 48HRS-7DAY
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 93244
|
| Hospital Charge Code |
7319324401
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.14
|
| Rate for Payer: Aetna Government |
$21.14
|
| Rate for Payer: Brighton Health Commercial |
$261.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| Rate for Payer: EmblemHealth Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Commercial |
$174.00
|
| Rate for Payer: Group Health Inc Medicare |
$121.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.67
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
|
