|
HC PLATELETS, LEUKOCYTES REDUCED, EACH UNIT
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT P9031
|
| Hospital Charge Code |
384P903101
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$1,069.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$735.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.67
|
| Rate for Payer: Aetna Government |
$153.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$107.57
|
| Rate for Payer: Brighton Health Commercial |
$153.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,069.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$909.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$153.67
|
| Rate for Payer: EmblemHealth Commercial |
$153.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$130.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.77
|
| Rate for Payer: Group Health Inc Commercial |
$153.67
|
| Rate for Payer: Group Health Inc Medicare |
$153.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.62
|
| Rate for Payer: Healthfirst QHP |
$153.67
|
| Rate for Payer: Humana Medicare |
$156.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.67
|
| Rate for Payer: United Healthcare Commercial |
$668.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.99
|
| Rate for Payer: Wellcare Medicare |
$138.30
|
|
|
HC PLATELETS, LEUKOCYTES REDUCED, EACH UNIT
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT P9031
|
| Hospital Charge Code |
384P903101
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
384P903501
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$416.61 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$852.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$595.15
|
| Rate for Payer: Aetna Government |
$595.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$416.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$416.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$416.61
|
| Rate for Payer: Brighton Health Commercial |
$595.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$595.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,054.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$595.15
|
| Rate for Payer: EmblemHealth Commercial |
$595.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$535.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$505.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$529.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$595.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$529.68
|
| Rate for Payer: Group Health Inc Commercial |
$595.15
|
| Rate for Payer: Group Health Inc Medicare |
$595.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$595.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$595.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$505.88
|
| Rate for Payer: Healthfirst QHP |
$595.15
|
| Rate for Payer: Humana Medicare |
$607.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$595.15
|
| Rate for Payer: United Healthcare Commercial |
$775.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$595.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$595.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$565.39
|
| Rate for Payer: Wellcare Medicare |
$535.63
|
|
|
HC PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT P9035
|
| Hospital Charge Code |
384P903501
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$775.00 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$775.00
|
|
|
HC PLATELETS,PHERSIS,PATHOGEN-REDUCE
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
384P907301
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$502.29 |
| Max. Negotiated Rate |
$1,389.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$955.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$717.55
|
| Rate for Payer: Aetna Government |
$717.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$502.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$502.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$502.29
|
| Rate for Payer: Brighton Health Commercial |
$717.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$717.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,389.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,181.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$717.55
|
| Rate for Payer: EmblemHealth Commercial |
$717.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$645.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$609.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$638.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$717.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$638.62
|
| Rate for Payer: Group Health Inc Commercial |
$717.55
|
| Rate for Payer: Group Health Inc Medicare |
$717.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$717.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$717.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$609.92
|
| Rate for Payer: Healthfirst QHP |
$717.55
|
| Rate for Payer: Humana Medicare |
$731.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$717.55
|
| Rate for Payer: United Healthcare Commercial |
$868.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$717.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$717.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$681.67
|
| Rate for Payer: Wellcare Medicare |
$645.79
|
|
|
HC PLATELETS,PHERSIS,PATHOGEN-REDUCE
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
CPT P9073
|
| Hospital Charge Code |
384P907301
|
|
Hospital Revenue Code
|
384
|
| Min. Negotiated Rate |
$868.50 |
| Max. Negotiated Rate |
$868.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$868.50
|
|
|
HC PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I
|
Facility
|
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
3615043201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$959.88 |
| Max. Negotiated Rate |
$4,023.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,034.97
|
| Rate for Payer: Aetna Government |
$1,034.97
|
| Rate for Payer: Brighton Health Commercial |
$4,023.75
|
| 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 |
$2,682.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,682.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,877.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.88
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
|
HC PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I
|
Facility
|
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
3615043201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,682.50 |
| Max. Negotiated Rate |
$2,682.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
|
|
HC PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 50433 TC
|
| Hospital Charge Code |
3615043301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$330.69 |
| Max. Negotiated Rate |
$6,856.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$330.69
|
| Rate for Payer: Aetna Government |
$330.69
|
| Rate for Payer: Brighton Health Commercial |
$6,856.50
|
| 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 |
$4,571.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,571.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,199.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.31
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
|
HC PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 50433 TC
|
| Hospital Charge Code |
3615043301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,571.00 |
| Max. Negotiated Rate |
$4,571.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.00
|
|
|
HC PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
3615069501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,571.00 |
| Max. Negotiated Rate |
$4,571.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.00
|
|
|
HC PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 50695
|
| Hospital Charge Code |
3615069501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$374.26 |
| Max. Negotiated Rate |
$6,856.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,214.02
|
| Rate for Payer: Aetna Government |
$4,214.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,949.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,949.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,949.81
|
| Rate for Payer: Brighton Health Commercial |
$6,856.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,214.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,214.02
|
| Rate for Payer: EmblemHealth Commercial |
$4,214.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,792.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,581.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,750.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,214.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,750.48
|
| Rate for Payer: Group Health Inc Commercial |
$4,214.02
|
| Rate for Payer: Group Health Inc Medicare |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$374.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,581.92
|
| Rate for Payer: Healthfirst QHP |
$4,214.02
|
| Rate for Payer: Humana Medicare |
$4,298.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,214.02
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,214.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,214.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,003.32
|
| Rate for Payer: Wellcare Medicare |
$4,003.32
|
|
|
HC PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
3615069301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,571.00 |
| Max. Negotiated Rate |
$4,571.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.00
|
|
|
HC PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
3615069301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$224.03 |
| Max. Negotiated Rate |
$6,856.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,214.02
|
| Rate for Payer: Aetna Government |
$4,214.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,949.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,949.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,949.81
|
| Rate for Payer: Brighton Health Commercial |
$6,856.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,214.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,214.02
|
| Rate for Payer: EmblemHealth Commercial |
$4,214.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,792.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,581.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,750.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,214.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,750.48
|
| Rate for Payer: Group Health Inc Commercial |
$4,214.02
|
| Rate for Payer: Group Health Inc Medicare |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$224.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,581.92
|
| Rate for Payer: Healthfirst QHP |
$4,214.02
|
| Rate for Payer: Humana Medicare |
$4,298.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,214.02
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,214.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,214.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,003.32
|
| Rate for Payer: Wellcare Medicare |
$4,003.32
|
|
|
HC PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 50694
|
| Hospital Charge Code |
3615069401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.18 |
| Max. Negotiated Rate |
$6,856.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,214.02
|
| Rate for Payer: Aetna Government |
$4,214.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,949.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,949.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,949.81
|
| Rate for Payer: Brighton Health Commercial |
$6,856.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,214.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,214.02
|
| Rate for Payer: EmblemHealth Commercial |
$4,214.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,792.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,581.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,750.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,214.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,750.48
|
| Rate for Payer: Group Health Inc Commercial |
$4,214.02
|
| Rate for Payer: Group Health Inc Medicare |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,581.92
|
| Rate for Payer: Healthfirst QHP |
$4,214.02
|
| Rate for Payer: Humana Medicare |
$4,298.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,214.02
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,214.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,214.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,003.32
|
| Rate for Payer: Wellcare Medicare |
$4,003.32
|
|
|
HC PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 50694
|
| Hospital Charge Code |
3615069401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,571.00 |
| Max. Negotiated Rate |
$4,571.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.00
|
|
|
HC PM DEVICE EVAL IN PERSON - CARD DEVICE IN CLINIC - PACEMAKER
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328803
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$63.02
|
| 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 PM DEVICE EVAL IN PERSON - CARD DEVICE IN CLINIC - PACEMAKER
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328803
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC PM DEVICE EVAL IN PERSON - CARD DEVICE INPATIENT - PACEMAKER
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328804
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC PM DEVICE EVAL IN PERSON - CARD DEVICE INPATIENT - PACEMAKER
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328804
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$63.02
|
| 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 PM DEVICE EVAL IN PERSON - CARDIAC DEVICE CHECK CHECK - INPATIENT
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328802
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC PM DEVICE EVAL IN PERSON - CARDIAC DEVICE CHECK CHECK - INPATIENT
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328802
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$63.02
|
| 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 PM DEVICE EVAL IN PERSON - CARDIAC DEVICE CHECK - IN CLINIC
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$63.02
|
| 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 PM DEVICE EVAL IN PERSON - CARDIAC DEVICE CHECK - IN CLINIC
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 93288
|
| Hospital Charge Code |
4809328801
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC PM DEVICE INTERROGATE REMOTE - CARD DEVICE REMOTE - PACEMAKER
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 93294
|
| Hospital Charge Code |
4809329402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.00
|
|
