St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTOGRAPHY - OD - RIGHT EYE

Facility

$330.00

Service Code	CPT 92286
Hospital Charge Code	9209228603
Hospital Revenue Code	920
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTOGRAPHY - OD - RIGHT EYE

Facility

$330.00

Service Code	CPT 92286
Hospital Charge Code	9209228603
Hospital Revenue Code	920
Min. Negotiated Rate	$43.74
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	$43.74
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	$94.00
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 INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTOGRAPHY - OS - LEFT EYE

Facility

$330.00

Service Code	CPT 92286
Hospital Charge Code	9209228604
Hospital Revenue Code	920
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTOGRAPHY - OS - LEFT EYE

Facility

$330.00

Service Code	CPT 92286
Hospital Charge Code	9209228604
Hospital Revenue Code	920
Min. Negotiated Rate	$43.74
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	$43.74
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	$94.00
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 INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTOGRAPHY - OU - BOTH EYES

Facility

$330.00

Service Code	CPT 92286
Hospital Charge Code	9209228605
Hospital Revenue Code	920
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00

HC INTERNAL EYE PHOTOGRAPHY - ENDOTHELIAL PHOTOGRAPHY - OU - BOTH EYES

Facility

$330.00

Service Code	CPT 92286
Hospital Charge Code	9209228605
Hospital Revenue Code	920
Min. Negotiated Rate	$43.74
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	$43.74
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	$94.00
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 INTERROGATE SUBQ DEFIB - CARD DEVICE IN CLINIC - SUBQ ICD

Facility

$122.00

Service Code	CPT 93261
Hospital Charge Code	4809326102
Hospital Revenue Code	480
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$61.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.00

HC INTERROGATE SUBQ DEFIB - CARD DEVICE IN CLINIC - SUBQ ICD

Facility

$122.00

Service Code	CPT 93261
Hospital Charge Code	4809326102
Hospital Revenue Code	480
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.10
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	$91.50
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	$97.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.96
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	$78.20
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 INTERROGATE SUBQ DEFIB - CARD DEVICE INPATIENT - SUBQ ICD

Facility

$122.00

Service Code	CPT 93261
Hospital Charge Code	4809326103
Hospital Revenue Code	480
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$61.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.00

HC INTERROGATE SUBQ DEFIB - CARD DEVICE INPATIENT - SUBQ ICD

Facility

$122.00

Service Code	CPT 93261
Hospital Charge Code	4809326103
Hospital Revenue Code	480
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.10
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	$91.50
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	$97.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.96
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	$78.20
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 INTERROGATE SUBQ DEFIB - CARDIAC DEVICE CHECK - IN CLINIC

Facility

$122.00

Service Code	CPT 93261
Hospital Charge Code	4809326101
Hospital Revenue Code	480
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$67.10
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	$91.50
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	$97.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.96
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	$78.20
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 INTERROGATE SUBQ DEFIB - CARDIAC DEVICE CHECK - IN CLINIC

Facility

$122.00

Service Code	CPT 93261
Hospital Charge Code	4809326101
Hospital Revenue Code	480
Min. Negotiated Rate	$61.00
Max. Negotiated Rate	$61.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$61.00

HC INTERROGATION DEVICE EVAL, REMOTE, W/ANA, IMPLANTABLE SYS

Facility

$71.00

Service Code	CPT 93297 TC
Hospital Charge Code	4809329701
Hospital Revenue Code	480
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.68
Rate for Payer: Aetna Government	$22.68
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	$41.76
Rate for Payer: United Healthcare Commercial	$316.00

HC INTERROGATION DEVICE EVAL, REMOTE, W/ANA, IMPLANTABLE SYS

Facility

$71.00

Service Code	CPT 93297 TC
Hospital Charge Code	4809329701
Hospital Revenue Code	480
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$35.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.50

HC INTERROGATION DEVICE EVAL, W/ANA, IMPLANTABLE SYS

Facility

$109.00

Service Code	CPT 93290 TC
Hospital Charge Code	4809329001
Hospital Revenue Code	480
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.74
Rate for Payer: Aetna Government	$8.74
Rate for Payer: Brighton Health Commercial	$81.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.12
Rate for Payer: EmblemHealth Commercial	$54.50
Rate for Payer: Group Health Inc Commercial	$54.50
Rate for Payer: Group Health Inc Medicare	$38.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50
Rate for Payer: Hamaspik Choice Inc Medicare	$54.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$37.10
Rate for Payer: United Healthcare Commercial	$316.00

HC INTERROGATION DEVICE EVAL, W/ANA, IMPLANTABLE SYS

Facility

$109.00

Service Code	CPT 93290 TC
Hospital Charge Code	4809329001
Hospital Revenue Code	480
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50

HC INTERROGATION DEVICE EVAL, W/ANA, WEARABLE SYS

Facility

$109.00

Service Code	CPT 93292 TC
Hospital Charge Code	4809329201
Hospital Revenue Code	480
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$316.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.01
Rate for Payer: Aetna Government	$10.01
Rate for Payer: Brighton Health Commercial	$81.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.12
Rate for Payer: EmblemHealth Commercial	$54.50
Rate for Payer: Group Health Inc Commercial	$54.50
Rate for Payer: Group Health Inc Medicare	$38.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50
Rate for Payer: Hamaspik Choice Inc Medicare	$54.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35.16
Rate for Payer: United Healthcare Commercial	$316.00

HC INTERROGATION DEVICE EVAL, W/ANA, WEARABLE SYS

Facility

$109.00

Service Code	CPT 93292 TC
Hospital Charge Code	4809329201
Hospital Revenue Code	480
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50

HC INTERROG DEVICE EVAL HEART - CARD DEVICE IN CLINIC - ICD

Facility

$109.00

Service Code	CPT 93289
Hospital Charge Code	4809328903
Hospital Revenue Code	480
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50

HC INTERROG DEVICE EVAL HEART - CARD DEVICE IN CLINIC - ICD

Facility

$109.00

Service Code	CPT 93289
Hospital Charge Code	4809328903
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	$79.93
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 INTERROG DEVICE EVAL HEART - CARD DEVICE INPATIENT - ICD

Facility

$109.00

Service Code	CPT 93289
Hospital Charge Code	4809328904
Hospital Revenue Code	480
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50

HC INTERROG DEVICE EVAL HEART - CARD DEVICE INPATIENT - ICD

Facility

$109.00

Service Code	CPT 93289
Hospital Charge Code	4809328904
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	$79.93
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 INTERROG DEVICE EVAL HEART - CARDIAC DEVICE CHECK CHECK - INPATIENT

Facility

$109.00

Service Code	CPT 93289
Hospital Charge Code	4809328902
Hospital Revenue Code	480
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50

HC INTERROG DEVICE EVAL HEART - CARDIAC DEVICE CHECK CHECK - INPATIENT

Facility

$109.00

Service Code	CPT 93289
Hospital Charge Code	4809328902
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	$79.93
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 INTERROG DEVICE EVAL HEART - CARDIAC DEVICE CHECK - IN CLINIC

Facility

$109.00

Service Code	CPT 93289
Hospital Charge Code	4809328901
Hospital Revenue Code	480
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$54.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.50

Know your out-of-pocket cost for care.

All Charges