|
HB LWR XTR FSCL PLN BLK UNI NJX
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
3616447301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.45 |
| 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 |
$65.45
|
|
|
HB LWR XTR FSCL PLN BLK UNI NJX
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 64473
|
| Hospital Charge Code |
3616447301
|
|
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 MRGFUS STRTCTC ABLT TRGT ICR
|
Facility
|
IP
|
$36,890.00
|
|
|
Service Code
|
CPT 61715
|
| Hospital Charge Code |
6106171501
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$18,445.00 |
| Max. Negotiated Rate |
$18,445.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,445.00
|
|
|
HB MRGFUS STRTCTC ABLT TRGT ICR
|
Facility
|
OP
|
$36,890.00
|
|
|
Service Code
|
CPT 61715
|
| Hospital Charge Code |
6106171501
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,355.64 |
| Max. Negotiated Rate |
$29,512.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,289.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15,236.47
|
| Rate for Payer: Aetna Government |
$15,236.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10,665.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10,665.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10,665.53
|
| Rate for Payer: Brighton Health Commercial |
$27,667.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15,236.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,512.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,085.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,236.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,355.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,712.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12,951.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13,560.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,236.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13,560.46
|
| Rate for Payer: Group Health Inc Commercial |
$13,712.82
|
| Rate for Payer: Group Health Inc Medicare |
$13,712.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,236.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15,236.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,506.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,951.00
|
| Rate for Payer: Healthfirst QHP |
$15,236.47
|
| Rate for Payer: Humana Medicare |
$15,541.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15,236.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,236.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15,236.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14,474.65
|
| Rate for Payer: Wellcare Medicare |
$14,474.65
|
|
|
HB MR SAFETY DETER PHYS/QHP
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
3207601601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.31 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$107.58
|
| Rate for Payer: Aetna Government |
$107.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$75.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$75.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$75.31
|
| Rate for Payer: Brighton Health Commercial |
$107.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$107.58
|
| Rate for Payer: EmblemHealth Commercial |
$75.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.75
|
| Rate for Payer: Group Health Inc Commercial |
$96.82
|
| Rate for Payer: Group Health Inc Medicare |
$96.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.58
|
| Rate for Payer: Healthfirst QHP |
$107.58
|
| Rate for Payer: Humana Medicare |
$109.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$102.20
|
| Rate for Payer: Wellcare Medicare |
$102.20
|
|
|
HB MR SAFETY DETER PHYS/QHP
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 76016
|
| Hospital Charge Code |
3207601601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.00
|
|
|
HB MR SAFETY IMPLANT ELEC PREPJ
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
3207601801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.50 |
| Max. Negotiated Rate |
$135.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.50
|
|
|
HB MR SAFETY IMPLANT ELEC PREPJ
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 76018
|
| Hospital Charge Code |
3207601801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.50 |
| Max. Negotiated Rate |
$216.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.15
|
| Rate for Payer: Aetna Government |
$112.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$78.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$78.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$78.50
|
| Rate for Payer: Brighton Health Commercial |
$112.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$216.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$112.15
|
| Rate for Payer: EmblemHealth Commercial |
$118.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.81
|
| Rate for Payer: Group Health Inc Commercial |
$100.94
|
| Rate for Payer: Group Health Inc Medicare |
$100.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.15
|
| Rate for Payer: Healthfirst QHP |
$112.15
|
| Rate for Payer: Humana Medicare |
$114.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$106.54
|
| Rate for Payer: Wellcare Medicare |
$106.54
|
|
|
HB MR SAFETY IMPLANT&/FB ASSMT CLIN STAF 1ST 15 MIN
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
3207601401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.00
|
|
|
HB MR SAFETY IMPLANT&/FB ASSMT CLIN STAF 1ST 15 MIN
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 76014
|
| Hospital Charge Code |
3207601401
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| Rate for Payer: Brighton Health Commercial |
$29.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$11.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| Rate for Payer: Group Health Inc Commercial |
$26.93
|
| Rate for Payer: Group Health Inc Medicare |
$26.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.92
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$28.42
|
|
|
HB MR SAFETY IMPLT POS&/IMMOBLJ
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 76019
|
| Hospital Charge Code |
3207601901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
|
|
HB MR SAFETY IMPLT POS&/IMMOBLJ
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 76019
|
| Hospital Charge Code |
3207601901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.81 |
| Max. Negotiated Rate |
$156.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$72.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$140.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$156.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$65.32
|
| Rate for Payer: Group Health Inc Medicare |
$65.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.58
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HB MR SFTY MED PHYSICS XM CSTMZ
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT 76017
|
| Hospital Charge Code |
3207601701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$393.25
|
| 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 |
$572.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$486.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$236.49
|
| 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 |
$236.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.34
|
| 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
|
|
|
HB MR SFTY MED PHYSICS XM CSTMZ
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT 76017
|
| Hospital Charge Code |
3207601701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.50 |
| Max. Negotiated Rate |
$357.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$357.50
|
|
|
HB MR SFTY MPLT&/FB ASMT STF EA
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
3207601501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
|
|
HB MR SFTY MPLT&/FB ASMT STF EA
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 76015
|
| Hospital Charge Code |
3207601501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$56.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.00
|
| Rate for Payer: Aetna Government |
$24.00
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.64
|
| Rate for Payer: EmblemHealth Commercial |
$56.58
|
| Rate for Payer: Group Health Inc Commercial |
$24.00
|
| Rate for Payer: Group Health Inc Medicare |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.58
|
|
|
HB MTB RIFAMPIN RST AMP PRB TQ
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 87564
|
| Hospital Charge Code |
3068756401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.00
|
|
|
HB MTB RIFAMPIN RST AMP PRB TQ
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 87564
|
| Hospital Charge Code |
3068756401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$93.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$76.77
|
| Rate for Payer: Aetna Government |
$76.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$53.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$53.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$53.74
|
| Rate for Payer: Brighton Health Commercial |
$85.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$91.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$76.77
|
| Rate for Payer: EmblemHealth Commercial |
$76.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.33
|
| Rate for Payer: Group Health Inc Commercial |
$76.77
|
| Rate for Payer: Group Health Inc Medicare |
$76.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.68
|
| Rate for Payer: Healthfirst Essential Plan |
$93.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.77
|
| Rate for Payer: Healthfirst QHP |
$76.77
|
| Rate for Payer: Humana Medicare |
$78.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.68
|
| Rate for Payer: Wellcare Medicare |
$69.09
|
|
|
HB NFCT DS BV&VAGINITIS DNA ALG
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 81515
|
| Hospital Charge Code |
3108151501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.00
|
|
|
HB NFCT DS BV&VAGINITIS DNA ALG
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 81515
|
| Hospital Charge Code |
3108151501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$184.09 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$231.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$262.99
|
| Rate for Payer: Aetna Government |
$262.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$184.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$184.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$184.09
|
| Rate for Payer: Brighton Health Commercial |
$262.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$262.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$336.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$285.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$262.99
|
| Rate for Payer: EmblemHealth Commercial |
$262.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$223.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.06
|
| Rate for Payer: Group Health Inc Commercial |
$262.99
|
| Rate for Payer: Group Health Inc Medicare |
$262.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$262.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$262.99
|
| Rate for Payer: Healthfirst QHP |
$262.99
|
| Rate for Payer: Humana Medicare |
$268.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$262.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$262.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$249.84
|
| Rate for Payer: Wellcare Medicare |
$236.69
|
|
|
HB PNEUMCYSTS JIROVECII AMP PRB
|
Facility
|
IP
|
$211.00
|
|
|
Service Code
|
CPT 87594
|
| Hospital Charge Code |
3068759401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$105.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.50
|
|
|
HB PNEUMCYSTS JIROVECII AMP PRB
|
Facility
|
OP
|
$211.00
|
|
|
Service Code
|
CPT 87594
|
| Hospital Charge Code |
3068759401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$168.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.05
|
| 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 |
$158.25
|
| 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 |
$168.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.48
|
| 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 |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| 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 |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HB STRPTCS PNEUM ANTB SEROT IA
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86581
|
| Hospital Charge Code |
3018658101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.50
|
| Rate for Payer: Aetna Government |
$52.50
|
| Rate for Payer: Brighton Health Commercial |
$78.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$71.40
|
| Rate for Payer: EmblemHealth Commercial |
$52.50
|
| Rate for Payer: Group Health Inc Commercial |
$52.50
|
| Rate for Payer: Group Health Inc Medicare |
$36.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.50
|
|
|
HB STRPTCS PNEUM ANTB SEROT IA
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86581
|
| Hospital Charge Code |
3018658101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.50
|
|
|
HB TAU PHOSPHORYLATED EACH
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 84393
|
| Hospital Charge Code |
3018439301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
