|
HC VASCULAR EMBOL/OCCLSN, VENOUS
|
Facility
|
IP
|
$30,010.00
|
|
|
Service Code
|
CPT 37241 TC
|
| Hospital Charge Code |
3613724101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,005.00 |
| Max. Negotiated Rate |
$15,005.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
|
|
HC VASCULAR EMBOL/OCCLSN, VENOUS
|
Facility
|
OP
|
$30,010.00
|
|
|
Service Code
|
CPT 37241 TC
|
| Hospital Charge Code |
3613724101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,485.00 |
| Max. Negotiated Rate |
$22,507.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,174.45
|
| Rate for Payer: Aetna Government |
$5,174.45
|
| Rate for Payer: Brighton Health Commercial |
$22,507.50
|
| 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 |
$15,005.00
|
| Rate for Payer: Group Health Inc Commercial |
$15,005.00
|
| Rate for Payer: Group Health Inc Medicare |
$10,503.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,454.19
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
|
|
HC VASCULAR STUDY - AORTOILIAC DUPLEX
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
9219397801
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC VASCULAR STUDY - AORTOILIAC DUPLEX
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
9219397801
|
|
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 |
$208.79
|
| 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 VASCULAR STUDY - ILIAC ARTERY DUPLEX
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
9219397802
|
|
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 |
$208.79
|
| 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 VASCULAR STUDY - ILIAC ARTERY DUPLEX
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
9219397802
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC VASCULAR STUDY - INFERIOR VENA CAVA DUPLEX
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
9219397803
|
|
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 |
$208.79
|
| 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 VASCULAR STUDY - INFERIOR VENA CAVA DUPLEX
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
9219397803
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC VASCULAR STUDY - PENILE DUPLEX
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
9219398001
|
|
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 |
$131.55
|
| 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 VASCULAR STUDY - PENILE DUPLEX
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
9219398001
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC VASCULAR STUDY - RENAL ARTERY DUPLEX
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9219397502
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC VASCULAR STUDY - RENAL ARTERY DUPLEX
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9219397502
|
|
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 VASCULAR STUDY - US RENAL ARTERY STENOSIS HYPERTENSION COMPLETE
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9219397501
|
|
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 VASCULAR STUDY - US RENAL ARTERY STENOSIS HYPERTENSION COMPLETE
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
9219397501
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC VASCULAR STUDY - US RETROPERITONEUM KIDNEY VESSELS
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
4029397501
|
|
Hospital Revenue Code
|
402
|
| 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 |
$295.34
|
| 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 |
$270.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.04
|
| 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 |
$265.81
|
| Rate for Payer: Group Health Inc Medicare |
$265.81
|
| 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 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 VASCULAR STUDY - US RETROPERITONEUM KIDNEY VESSELS
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
4029397501
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC VASCULAR SURGERY PROCEDURE UNLIST - BUNDLED CHARGE
|
Facility
|
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
3613779902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$528.78 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$755.40
|
| Rate for Payer: Aetna Government |
$755.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$528.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$528.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$528.78
|
| Rate for Payer: Brighton Health Commercial |
$1,431.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$755.40
|
| 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 |
$755.40
|
| Rate for Payer: EmblemHealth Commercial |
$755.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$679.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$642.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$672.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$755.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$672.31
|
| Rate for Payer: Group Health Inc Commercial |
$755.40
|
| Rate for Payer: Group Health Inc Medicare |
$755.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$755.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$755.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$642.09
|
| Rate for Payer: Healthfirst QHP |
$755.40
|
| Rate for Payer: Humana Medicare |
$770.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$755.40
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$755.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$755.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$717.63
|
| Rate for Payer: Wellcare Medicare |
$717.63
|
|
|
HC VASCULAR SURGERY PROCEDURE UNLIST - BUNDLED CHARGE
|
Facility
|
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
3613779902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$954.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
|
|
HC VASCULAR SURGERY - UNLISTED PROCEDURE
|
Facility
|
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
3613779901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$528.78 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$755.40
|
| Rate for Payer: Aetna Government |
$755.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$528.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$528.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$528.78
|
| Rate for Payer: Brighton Health Commercial |
$1,431.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$755.40
|
| 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 |
$755.40
|
| Rate for Payer: EmblemHealth Commercial |
$755.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$679.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$642.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$672.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$755.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$672.31
|
| Rate for Payer: Group Health Inc Commercial |
$755.40
|
| Rate for Payer: Group Health Inc Medicare |
$755.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$755.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$755.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$642.09
|
| Rate for Payer: Healthfirst QHP |
$755.40
|
| Rate for Payer: Humana Medicare |
$770.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$755.40
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$755.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$755.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$717.63
|
| Rate for Payer: Wellcare Medicare |
$717.63
|
|
|
HC VASCULAR SURGERY - UNLISTED PROCEDURE
|
Facility
|
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
3613779901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$954.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
|
|
HC VEEG 2-12 HR CONTIN MONITOR
|
Facility
|
OP
|
$1,470.00
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
7409571301
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$453.81 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.30
|
| Rate for Payer: Aetna Government |
$648.30
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$453.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$453.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$453.81
|
| Rate for Payer: Brighton Health Commercial |
$1,102.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$648.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$999.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$648.30
|
| Rate for Payer: EmblemHealth Commercial |
$648.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$583.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$551.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$648.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.99
|
| Rate for Payer: Group Health Inc Commercial |
$648.30
|
| Rate for Payer: Group Health Inc Medicare |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$648.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$648.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$551.05
|
| Rate for Payer: Healthfirst QHP |
$648.30
|
| Rate for Payer: Humana Medicare |
$661.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$648.30
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$648.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$648.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$615.88
|
| Rate for Payer: Wellcare Medicare |
$615.88
|
|
|
HC VEEG 2-12 HR CONTIN MONITOR
|
Facility
|
IP
|
$1,470.00
|
|
|
Service Code
|
CPT 95713
|
| Hospital Charge Code |
7409571301
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.00
|
|
|
HC VEEG 2-12 HR INTRMIT MONITOR
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
7409571201
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$266.33 |
| Max. Negotiated Rate |
$822.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC VEEG 2-12 HR INTRMIT MONITOR
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 95712
|
| Hospital Charge Code |
7409571201
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC VEEG 2-12 HR UNMONITORED
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 95711
|
| Hospital Charge Code |
7409571101
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$266.33 |
| Max. Negotiated Rate |
$822.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
