|
HC IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
6369068801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.50 |
| Max. Negotiated Rate |
$236.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.50
|
|
|
HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
6369065301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$98.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.02
|
| Rate for Payer: Aetna Government |
$54.02
|
| Rate for Payer: Brighton Health Commercial |
$16.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.53
|
| Rate for Payer: EmblemHealth Commercial |
$13.50
|
| Rate for Payer: Group Health Inc Commercial |
$13.50
|
| Rate for Payer: Group Health Inc Medicare |
$9.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.55
|
|
|
HC IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
6369065301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.50
|
|
|
HC IIV VACCINE PRESERV FREE INCREASED AG COUNT IM
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$98.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.26
|
| Rate for Payer: Aetna Government |
$65.26
|
| Rate for Payer: Brighton Health Commercial |
$20.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.55
|
| Rate for Payer: EmblemHealth Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.16
|
| Rate for Payer: United Healthcare Commercial |
$69.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
HC IIV VACCINE PRESERV FREE INCREASED AG COUNT IM
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
6369066201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
|
|
HC IKBKAP GENE ANALYSIS - FAMILIAL DYSAUTONOMIA
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 81260
|
| Hospital Charge Code |
3108126001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.00
|
|
|
HC IKBKAP GENE ANALYSIS - FAMILIAL DYSAUTONOMIA
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 81260
|
| Hospital Charge Code |
3108126001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$78.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.31
|
| Rate for Payer: Aetna Government |
$39.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.52
|
| Rate for Payer: Brighton Health Commercial |
$39.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$39.31
|
| Rate for Payer: EmblemHealth Commercial |
$39.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.99
|
| Rate for Payer: Group Health Inc Commercial |
$39.31
|
| Rate for Payer: Group Health Inc Medicare |
$39.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.31
|
| Rate for Payer: Healthfirst QHP |
$39.31
|
| Rate for Payer: Humana Medicare |
$40.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.34
|
| Rate for Payer: Wellcare Medicare |
$35.38
|
|
|
HC ILR DEVICE EVAL PROGR - CARD DEVICE IN CLINIC LOOP RECORDER (ILR)
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4809328503
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC ILR DEVICE EVAL PROGR - CARD DEVICE IN CLINIC LOOP RECORDER (ILR)
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4809328503
|
|
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 |
$66.74
|
| 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 ILR DEVICE EVAL PROGR - CARD DEVICE INPATIENT LOOP RECORDER (ILR)
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4809328504
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC ILR DEVICE EVAL PROGR - CARD DEVICE INPATIENT LOOP RECORDER (ILR)
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4809328504
|
|
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 |
$66.74
|
| 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 ILR DEVICE EVAL PROGR - CARDIAC DEVICE CHECK CHECK - INPATIENT
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4809328502
|
|
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 |
$66.74
|
| 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 ILR DEVICE EVAL PROGR - CARDIAC DEVICE CHECK CHECK - INPATIENT
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4809328502
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC ILR DEVICE EVAL PROGR - CARDIAC DEVICE CHECK - IN CLINIC
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4809328501
|
|
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 |
$66.74
|
| 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 ILR DEVICE EVAL PROGR - CARDIAC DEVICE CHECK - IN CLINIC
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4809328501
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC ILR DEVICE INTERROGATE - CARD DEVICE IMPLANT/POST-PROC LOOP RCRDR
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329104
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$29.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| Rate for Payer: Group Health Inc Commercial |
$29.92
|
| Rate for Payer: Group Health Inc Medicare |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.43
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$28.42
|
|
|
HC ILR DEVICE INTERROGATE - CARD DEVICE IMPLANT/POST-PROC LOOP RCRDR
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329104
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC ILR DEVICE INTERROGATE - CARD DEVICE IN CLINIC - LOOP RECORDER (ILR)
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$29.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| Rate for Payer: Group Health Inc Commercial |
$29.92
|
| Rate for Payer: Group Health Inc Medicare |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.43
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$28.42
|
|
|
HC ILR DEVICE INTERROGATE - CARD DEVICE IN CLINIC - LOOP RECORDER (ILR)
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC ILR DEVICE INTERROGATE - CARD DEVICE INPATIENT - LOOP RECORDER (ILR)
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$29.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| Rate for Payer: Group Health Inc Commercial |
$29.92
|
| Rate for Payer: Group Health Inc Medicare |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.43
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$28.42
|
|
|
HC ILR DEVICE INTERROGATE - CARD DEVICE INPATIENT - LOOP RECORDER (ILR)
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC ILR DEVICE INTERROGATE - CARDIAC DEVICE CHECK - IMPLANT/POST-OP
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| Rate for Payer: Brighton Health Commercial |
$81.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| 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 |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$29.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| Rate for Payer: Group Health Inc Commercial |
$29.92
|
| Rate for Payer: Group Health Inc Medicare |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.43
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$28.42
|
|
|
HC ILR DEVICE INTERROGATE - CARDIAC DEVICE CHECK - IMPLANT/POST-OP
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC ILR DEVICE INTERROGATE - CARDIAC DEVICE CHECK - IN CLINIC
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329102
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| Rate for Payer: Brighton Health Commercial |
$81.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| 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 |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$29.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| Rate for Payer: Group Health Inc Commercial |
$29.92
|
| Rate for Payer: Group Health Inc Medicare |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.43
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$28.42
|
|
|
HC ILR DEVICE INTERROGATE - CARDIAC DEVICE CHECK - IN CLINIC
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93291
|
| Hospital Charge Code |
4809329102
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
