|
HC EXTERNAL ELECTROCARDIOGRAPHIC RECORD FOR > 7DYS-15DYS
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
7319324701
|
|
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 > 7DYS-15DYS
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
7319324701
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$282.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$261.00
|
| 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 |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| 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 |
$282.03
|
| 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 EXTERNAL ELECTROCARDIOGRAPHIC RECORDING > 7DYS-15DYS
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
7319324601
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.60
|
| 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 |
$129.00
|
| 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 |
$137.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.96
|
| 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 |
$13.82
|
| 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 |
$253.00
|
| 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 EXTERNAL ELECTROCARDIOGRAPHIC RECORDING > 7DYS-15DYS
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
7319324601
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.00
|
|
|
HC EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR > 48HR-7DAYS
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 93241
|
| Hospital Charge Code |
7319324101
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$310.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.57
|
| Rate for Payer: Aetna Government |
$69.57
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.68
|
| Rate for Payer: EmblemHealth Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Medicare |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$310.43
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
|
|
HC EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR > 48HR-7DAYS
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 93241
|
| Hospital Charge Code |
7319324101
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR > 48HRS-7DAYS
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
7319324301
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| 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 |
$261.00
|
| 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 |
$278.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$236.64
|
| 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 |
$271.94
|
| 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 EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR > 48HRS-7DAYS
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
7319324301
|
|
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 RECORDING FOR > 48HR TO 7DYS
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
7319324201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$253.00 |
| 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 |
$13.82
|
| 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 |
$253.00
|
| 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 EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR > 48HR TO 7DYS
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
7319324201
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR > 7DAY-15DAY
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 93248
|
| Hospital Charge Code |
7319324801
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$191.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.18
|
| Rate for Payer: Aetna Government |
$23.18
|
| 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 |
$27.17
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
|
|
HC EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR > 7DAY-15DAY
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 93248
|
| Hospital Charge Code |
7319324801
|
|
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 RECORDING FOR > 7DAYS-15DAYS
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 93245
|
| Hospital Charge Code |
7319324501
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$323.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.57
|
| Rate for Payer: Aetna Government |
$69.57
|
| Rate for Payer: Brighton Health Commercial |
$129.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$137.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.96
|
| Rate for Payer: EmblemHealth Commercial |
$86.00
|
| Rate for Payer: Group Health Inc Commercial |
$86.00
|
| Rate for Payer: Group Health Inc Medicare |
$60.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$323.02
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
|
|
HC EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR > 7DAYS-15DAYS
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 93245
|
| Hospital Charge Code |
7319324501
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.00
|
|
|
HC EXTERNAL OCULAR PHOTOGRAPHY W INTERPN AND RPT
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 92285
|
| Hospital Charge Code |
9209228501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC EXTERNAL OCULAR PHOTOGRAPHY W INTERPN AND RPT
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 92285
|
| Hospital Charge Code |
9209228501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| 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 |
$124.50
|
| 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 |
$132.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
| 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 |
$27.02
|
| 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 |
$94.00
|
| 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 EXT MOBILE CARDIOVASC TELEMETRY W/RECORDING, 1-30 DAYS
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 93228
|
| Hospital Charge Code |
9859322801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
|
|
HC EXT MOBILE CARDIOVASC TELEMETRY W/RECORDING, 1-30 DAYS
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 93228
|
| Hospital Charge Code |
9859322801
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$56.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Government |
$22.36
|
| 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 |
$27.71
|
|
|
HC EXTRACT ERUPTED TOOTH/EXPOSE ROOT
|
Facility
|
IP
|
$2,953.00
|
|
|
Service Code
|
CPT D7140
|
| Hospital Charge Code |
361D714001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,476.50 |
| Max. Negotiated Rate |
$1,476.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,476.50
|
|
|
HC EXTRACT ERUPTED TOOTH/EXPOSE ROOT
|
Facility
|
OP
|
$2,953.00
|
|
|
Service Code
|
CPT D7140
|
| Hospital Charge Code |
361D714001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$892.61 |
| Max. Negotiated Rate |
$2,362.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,624.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,031.43
|
| Rate for Payer: Aetna Government |
$2,031.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,422.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,422.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,422.00
|
| Rate for Payer: Brighton Health Commercial |
$2,214.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,031.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,362.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,008.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,031.43
|
| Rate for Payer: EmblemHealth Commercial |
$2,031.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,828.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,726.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,807.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,031.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,807.97
|
| Rate for Payer: Group Health Inc Commercial |
$2,031.43
|
| Rate for Payer: Group Health Inc Medicare |
$2,031.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,031.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$892.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,726.72
|
| Rate for Payer: Healthfirst QHP |
$2,031.43
|
| Rate for Payer: Humana Medicare |
$2,072.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,031.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,031.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,031.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,929.86
|
| Rate for Payer: Wellcare Medicare |
$1,929.86
|
|
|
HC EYE EXAM, EST PATIENT,INTERMED
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 92012
|
| Hospital Charge Code |
5109201201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$251.50 |
| Max. Negotiated Rate |
$251.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.50
|
|
|
HC EYE EXAM, EST PATIENT,INTERMED
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 92012
|
| Hospital Charge Code |
5109201201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$276.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.46
|
| Rate for Payer: Aetna Government |
$157.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.22
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.46
|
| 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 |
$157.46
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.14
|
| 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 |
$157.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.84
|
| Rate for Payer: Healthfirst QHP |
$157.46
|
| Rate for Payer: Humana Medicare |
$160.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.46
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.59
|
| Rate for Payer: Wellcare Medicare |
$149.59
|
|
|
HC EYE PHOTOGRAPHY - CORNEOSCOPE - OD - RIGHT EYE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 92285
|
| Hospital Charge Code |
9209228504
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| 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 |
$124.50
|
| 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 |
$132.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
| 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 |
$27.02
|
| 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 |
$94.00
|
| 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 EYE PHOTOGRAPHY - CORNEOSCOPE - OD - RIGHT EYE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 92285
|
| Hospital Charge Code |
9209228504
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC EYE PHOTOGRAPHY - CORNEOSCOPE - OS - LEFT EYE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 92285
|
| Hospital Charge Code |
9209228505
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| 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 |
$124.50
|
| 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 |
$132.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
| 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 |
$27.02
|
| 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 |
$94.00
|
| 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
|
|
