|
HC VAGINAL DELIVERY ONLY - MULTIPLE DELIVERIES
|
Facility
|
OP
|
$9,896.00
|
|
| Hospital Charge Code |
7225940903
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$3,463.60 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,442.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,948.00
|
| Rate for Payer: Aetna Government |
$4,948.00
|
| Rate for Payer: Brighton Health Commercial |
$7,422.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,916.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,729.28
|
| Rate for Payer: EmblemHealth Commercial |
$4,948.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,948.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,463.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,948.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,948.00
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
|
|
HC VAGINAL DELIVERY ONLY - MULTIPLE DELIVERIES
|
Facility
|
IP
|
$9,896.00
|
|
| Hospital Charge Code |
7225940903
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$4,948.00 |
| Max. Negotiated Rate |
$4,948.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,948.00
|
|
|
HC VAGINAL L&D CHARGE
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
7205940001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$850.00 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.00
|
|
|
HC VAGINAL L&D CHARGE
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
CPT 59400
|
| Hospital Charge Code |
7205940001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$935.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,473.00
|
| Rate for Payer: Aetna Government |
$2,473.00
|
| Rate for Payer: Brighton Health Commercial |
$1,275.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,156.00
|
| Rate for Payer: EmblemHealth Commercial |
$850.00
|
| Rate for Payer: Group Health Inc Commercial |
$850.00
|
| Rate for Payer: Group Health Inc Medicare |
$595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,896.36
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3028678701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3028678701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3028678702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3028678702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
6369071601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
|
|
HC VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
6369071601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$153.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.87
|
| Rate for Payer: Aetna Government |
$153.87
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.38
|
| Rate for Payer: EmblemHealth Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.25
|
|
|
HC VASC CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP
|
Facility
|
OP
|
$8,631.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
3619345402
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,003.41 |
| Max. Negotiated Rate |
$6,904.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,387.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,929.87
|
| Rate for Payer: Aetna Government |
$3,929.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,750.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,750.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,750.91
|
| Rate for Payer: Brighton Health Commercial |
$6,473.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,929.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,904.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,869.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,929.87
|
| Rate for Payer: EmblemHealth Commercial |
$3,929.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,536.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,340.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,497.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,929.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,497.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,929.87
|
| Rate for Payer: Group Health Inc Medicare |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,929.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,003.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,340.39
|
| Rate for Payer: Healthfirst QHP |
$3,929.87
|
| Rate for Payer: Humana Medicare |
$4,008.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,929.87
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,929.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,929.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,733.38
|
| Rate for Payer: Wellcare Medicare |
$3,733.38
|
|
|
HC VASC CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP
|
Facility
|
IP
|
$8,631.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
3619345402
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,315.50 |
| Max. Negotiated Rate |
$4,315.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,315.50
|
|
|
HC VASC DUPLEX ABD/PEL VASC STUDY,COMPLETE
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9219397504
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC VASC DUPLEX ABD/PEL VASC STUDY,COMPLETE
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9219397504
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.34
|
| Rate for Payer: Aetna Government |
$295.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$206.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$206.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$206.74
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$295.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.85
|
| Rate for Payer: Group Health Inc Commercial |
$295.34
|
| Rate for Payer: Group Health Inc Medicare |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.04
|
| Rate for Payer: Healthfirst QHP |
$295.34
|
| Rate for Payer: Humana Medicare |
$301.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.34
|
| Rate for Payer: United Healthcare Commercial |
$352.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$280.57
|
| Rate for Payer: Wellcare Medicare |
$280.57
|
|
|
HC VASC DUPLEX EXTREM VENOUS,BILAT
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93970 50
|
| Hospital Charge Code |
9219397006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC VASC DUPLEX EXTREM VENOUS,BILAT
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93970 50
|
| Hospital Charge Code |
9219397006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$136.35
|
| Rate for Payer: Aetna Government |
$136.35
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.40
|
| Rate for Payer: EmblemHealth Commercial |
$352.50
|
| Rate for Payer: Group Health Inc Commercial |
$352.50
|
| Rate for Payer: Group Health Inc Medicare |
$246.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.50
|
| Rate for Payer: United Healthcare Commercial |
$352.50
|
|
|
HC VASC DUPLEX LO EXTREM ART UNILAT/LTD
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
9219392603
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC VASC DUPLEX LO EXTREM ART UNILAT/LTD
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
9219392603
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC VASC DUPLEX SCAN EXTRACRANIAL,LIMITED
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
9219388204
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC VASC DUPLEX SCAN EXTRACRANIAL,LIMITED
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93882
|
| Hospital Charge Code |
9219388204
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC VASC DUPLEX UP EXTREM ART BILAT
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
9219393006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.34
|
| Rate for Payer: Aetna Government |
$295.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$206.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$206.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$206.74
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$295.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.85
|
| Rate for Payer: Group Health Inc Commercial |
$295.34
|
| Rate for Payer: Group Health Inc Medicare |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$228.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.04
|
| Rate for Payer: Healthfirst QHP |
$295.34
|
| Rate for Payer: Humana Medicare |
$301.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.34
|
| Rate for Payer: United Healthcare Commercial |
$352.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$280.57
|
| Rate for Payer: Wellcare Medicare |
$280.57
|
|
|
HC VASC DUPLEX UP EXTREM ART BILAT
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
9219393006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC VASC DUPLEX UP EXTREM ART UNILAT/LTD
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
9219393103
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC VASC DUPLEX UP EXTREM ART UNILAT/LTD
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93931
|
| Hospital Charge Code |
9219393103
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$129.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$129.93
|
| Rate for Payer: Group Health Inc Medicare |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Commercial |
$169.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC VASC ILIAC ART ANGIO,CARDIAC CATH
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
921G027801
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$747.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.99
|
| Rate for Payer: Aetna Government |
$8.99
|
| Rate for Payer: Brighton Health Commercial |
$700.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.12
|
| Rate for Payer: EmblemHealth Commercial |
$467.00
|
| Rate for Payer: Group Health Inc Commercial |
$467.00
|
| Rate for Payer: Group Health Inc Medicare |
$326.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.20
|
| Rate for Payer: United Healthcare Commercial |
$467.00
|
|
