|
HB CYTOG GENOM-WID ALYS HEM MAL
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 81195
|
| Hospital Charge Code |
3108119501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$1,288.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,263.53
|
| Rate for Payer: Aetna Government |
$1,263.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$884.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$884.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$884.47
|
| Rate for Payer: Brighton Health Commercial |
$1,263.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,263.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,263.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,263.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,137.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,074.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,124.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,263.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,124.54
|
| Rate for Payer: Group Health Inc Commercial |
$1,263.53
|
| Rate for Payer: Group Health Inc Medicare |
$1,263.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,263.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,263.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,263.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,263.53
|
| Rate for Payer: Healthfirst QHP |
$1,263.53
|
| Rate for Payer: Humana Medicare |
$1,288.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,263.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,263.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,263.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,200.35
|
| Rate for Payer: Wellcare Medicare |
$1,137.18
|
|
|
HB EMBOLI DETCJ WO IV MBUBB NJX
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
CPT 93897
|
| Hospital Charge Code |
9209389701
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$207.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$188.50
|
| Rate for Payer: Aetna Government |
$188.50
|
| Rate for Payer: Brighton Health Commercial |
$282.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$301.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$256.36
|
| Rate for Payer: EmblemHealth Commercial |
$188.50
|
| Rate for Payer: Group Health Inc Commercial |
$188.50
|
| Rate for Payer: Group Health Inc Medicare |
$131.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$188.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$259.65
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
HB EMBOLI DETCJ WO IV MBUBB NJX
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
CPT 93897
|
| Hospital Charge Code |
9209389701
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$188.50
|
|
|
HB ENDOMYSIAL ANTIBODY (EMA), EACH IMMUNOGLOBULIN (IG) CLASS
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
3028623101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HB ENDOMYSIAL ANTIBODY (EMA), EACH IMMUNOGLOBULIN (IG) CLASS
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
3028623101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.09
|
| Rate for Payer: Aetna Government |
$12.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.46
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.09
|
| Rate for Payer: EmblemHealth Commercial |
$12.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.76
|
| Rate for Payer: Group Health Inc Commercial |
$12.09
|
| Rate for Payer: Group Health Inc Medicare |
$12.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.32
|
| Rate for Payer: Healthfirst Essential Plan |
$16.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.09
|
| Rate for Payer: Healthfirst QHP |
$12.09
|
| Rate for Payer: Humana Medicare |
$12.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.09
|
| Rate for Payer: United Healthcare Commercial |
$10.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.32
|
| Rate for Payer: Wellcare Medicare |
$10.88
|
|
|
HB FIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
3058539001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Government |
$15.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.84
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.48
|
| Rate for Payer: EmblemHealth Commercial |
$15.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.78
|
| Rate for Payer: Group Health Inc Commercial |
$15.48
|
| Rate for Payer: Group Health Inc Medicare |
$15.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.48
|
| Rate for Payer: Healthfirst QHP |
$15.48
|
| Rate for Payer: Humana Medicare |
$15.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.48
|
| Rate for Payer: United Healthcare Commercial |
$6.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.71
|
| Rate for Payer: Wellcare Medicare |
$13.93
|
|
|
HB FIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
3058539001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HB GENETIC TESTING FOR SEVERE INHERITED CONDITIONS
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 81443
|
| Hospital Charge Code |
3108144301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.00
|
|
|
HB GENETIC TESTING FOR SEVERE INHERITED CONDITIONS
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 81443
|
| Hospital Charge Code |
3108144301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$2,497.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,448.56
|
| Rate for Payer: Aetna Government |
$2,448.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,713.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,713.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,713.99
|
| Rate for Payer: Brighton Health Commercial |
$2,448.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,448.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$273.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$232.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,448.56
|
| Rate for Payer: EmblemHealth Commercial |
$2,448.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,203.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,081.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,179.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,448.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,179.22
|
| Rate for Payer: Group Health Inc Commercial |
$2,448.56
|
| Rate for Payer: Group Health Inc Medicare |
$2,448.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,448.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,448.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,448.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,448.56
|
| Rate for Payer: Healthfirst QHP |
$2,448.56
|
| Rate for Payer: Humana Medicare |
$2,497.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,448.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,448.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,448.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,326.13
|
| Rate for Payer: Wellcare Medicare |
$2,203.70
|
|
|
HB H PYLRI CLRTHMCN RST AMP PRB
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 87513
|
| Hospital Charge Code |
3068751301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$80.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$85.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$72.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$33.34
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HB H PYLRI CLRTHMCN RST AMP PRB
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 87513
|
| Hospital Charge Code |
3068751301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$53.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.50
|
|
|
HB IADNA HPV SEP RPRT HI-RSK TYP&HI-RSK POOLD RSLTS
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
3068762601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.00
|
|
|
HB IADNA HPV SEP RPRT HI-RSK TYP&HI-RSK POOLD RSLTS
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
3068762601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$94.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.20
|
| Rate for Payer: Aetna Government |
$70.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.14
|
| Rate for Payer: Brighton Health Commercial |
$72.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$76.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.20
|
| Rate for Payer: EmblemHealth Commercial |
$70.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.48
|
| Rate for Payer: Group Health Inc Commercial |
$70.20
|
| Rate for Payer: Group Health Inc Medicare |
$70.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.12
|
| Rate for Payer: Healthfirst Essential Plan |
$94.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.20
|
| Rate for Payer: Healthfirst QHP |
$70.20
|
| Rate for Payer: Humana Medicare |
$71.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$42.12
|
| Rate for Payer: Wellcare Medicare |
$63.18
|
|
|
HB IMPLANTATION IRIS PROSTHESIS
|
Facility
|
OP
|
$48,563.00
|
|
|
Service Code
|
CPT 66683
|
| Hospital Charge Code |
3616668301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$870.85 |
| Max. Negotiated Rate |
$36,422.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,709.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,057.93
|
| Rate for Payer: Aetna Government |
$20,057.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14,040.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14,040.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14,040.55
|
| Rate for Payer: Brighton Health Commercial |
$36,422.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,057.93
|
| 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 |
$20,057.93
|
| Rate for Payer: EmblemHealth Commercial |
$20,057.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,052.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17,049.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17,851.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,057.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17,851.56
|
| Rate for Payer: Group Health Inc Commercial |
$20,057.93
|
| Rate for Payer: Group Health Inc Medicare |
$20,057.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,057.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13,885.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$870.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,049.24
|
| Rate for Payer: Healthfirst QHP |
$20,057.93
|
| Rate for Payer: Humana Medicare |
$20,459.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,057.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,057.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,057.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,055.03
|
| Rate for Payer: Wellcare Medicare |
$19,055.03
|
|
|
HB IMPLANTATION IRIS PROSTHESIS
|
Facility
|
IP
|
$48,563.00
|
|
|
Service Code
|
CPT 66683
|
| Hospital Charge Code |
3616668301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24,281.50 |
| Max. Negotiated Rate |
$24,281.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,281.50
|
|
|
HB INDIV PSYCH THERAPY INCORPORATING BIOFEEDBACK 30MINS
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 90875
|
| Hospital Charge Code |
9149087501
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$238.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$163.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.33
|
| Rate for Payer: Aetna Government |
$52.33
|
| Rate for Payer: Brighton Health Commercial |
$223.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$238.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$202.64
|
| Rate for Payer: EmblemHealth Commercial |
$149.00
|
| Rate for Payer: Group Health Inc Commercial |
$149.00
|
| Rate for Payer: Group Health Inc Medicare |
$104.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.00
|
|
|
HB INDIV PSYCH THERAPY INCORPORATING BIOFEEDBACK 30MINS
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 90875
|
| Hospital Charge Code |
9149087501
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$149.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.00
|
|
|
HB INTRADERMAL INTRO OF INSOLUBLE OPAQUE PIGMENTS 6.0SQ CM OR LESS
|
Facility
|
IP
|
$1,452.00
|
|
|
Service Code
|
CPT 11920
|
| Hospital Charge Code |
5101192001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$726.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$726.00
|
|
|
HB INTRADERMAL INTRO OF INSOLUBLE OPAQUE PIGMENTS 6.0SQ CM OR LESS
|
Facility
|
OP
|
$1,452.00
|
|
|
Service Code
|
CPT 11920
|
| Hospital Charge Code |
5101192001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.94 |
| Max. Negotiated Rate |
$785.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$785.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HB INTRADERMAL INTRO OF INSOLUBLE OPAQUE PIGMENTS 6.1-20.0SQ CM
|
Facility
|
IP
|
$1,815.00
|
|
|
Service Code
|
CPT 11921
|
| Hospital Charge Code |
5101192101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$907.50 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$907.50
|
|
|
HB INTRADERMAL INTRO OF INSOLUBLE OPAQUE PIGMENTS 6.1-20.0SQ CM
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
CPT 11921
|
| Hospital Charge Code |
5101192101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.74 |
| Max. Negotiated Rate |
$785.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$785.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HB INTRADERMAL INTRO OF INSOLUBLE OPAQUE PIGMENTS EACH ADDL 20.0SQ CM
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
CPT 11922
|
| Hospital Charge Code |
5101192201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$363.00
|
|
|
HB INTRADERMAL INTRO OF INSOLUBLE OPAQUE PIGMENTS EACH ADDL 20.0SQ CM
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
CPT 11922
|
| Hospital Charge Code |
5101192201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.71 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.71
|
| Rate for Payer: Aetna Government |
$25.71
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$363.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$363.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.69
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HB LWR XTR FSCL PLN BLK UNI NFS
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 64474
|
| Hospital Charge Code |
3616447401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,097.00 |
| Max. Negotiated Rate |
$1,097.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,097.00
|
|
|
HB LWR XTR FSCL PLN BLK UNI NFS
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 64474
|
| Hospital Charge Code |
3616447401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.39 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,206.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,097.00
|
| Rate for Payer: Aetna Government |
$1,097.00
|
| Rate for Payer: Brighton Health Commercial |
$1,645.50
|
| 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 |
$1,097.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,097.00
|
| Rate for Payer: Group Health Inc Medicare |
$767.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,097.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,097.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.39
|
|
