|
HC ACNE SURGERY
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
3611004001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$58.88 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC ACNE SURGERY
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 10040
|
| Hospital Charge Code |
3611004001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
4719257001
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$31.44 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC ACOUSTIC IMMIT TEST TYMPANOMETRY/ACOUST REFLEX/DECAY
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
4719257001
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC ACOUSTIC REFLEX TESTING
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 92568
|
| Hospital Charge Code |
4719256801
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC ACOUSTIC REFLEX TESTING
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 92568
|
| Hospital Charge Code |
4719256801
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.96
|
| Rate for Payer: Aetna Government |
$47.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.57
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.96
|
| Rate for Payer: EmblemHealth Commercial |
$47.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.68
|
| Rate for Payer: Group Health Inc Commercial |
$47.96
|
| Rate for Payer: Group Health Inc Medicare |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.77
|
| Rate for Payer: Healthfirst QHP |
$47.96
|
| Rate for Payer: Humana Medicare |
$48.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45.56
|
| Rate for Payer: Wellcare Medicare |
$45.56
|
|
|
HC ACP DISCUS/DSCN MKR DOCD
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 1123F
|
| Hospital Charge Code |
9691123F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC ACP DISCUS/DSCN MKR DOCD
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 1123F
|
| Hospital Charge Code |
9691123F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: EmblemHealth Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
HC ACTIN (SMOOTH MUSCLE) ANTIBODY (ASMA), EACH
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
3028601501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.44
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.98
|
| Rate for Payer: Healthfirst Essential Plan |
$15.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Humana Medicare |
$12.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare Commercial |
$10.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.98
|
| Rate for Payer: Wellcare Medicare |
$10.85
|
|
|
HC ACTIN (SMOOTH MUSCLE) ANTIBODY (ASMA), EACH
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
3028601501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.50
|
|
|
HC ACUTE GI BLOOD LOSS IMAGING - NM GASTROINTESTINAL BLEEDING
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78278 TC
|
| Hospital Charge Code |
3417827801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC ACUTE GI BLOOD LOSS IMAGING - NM GASTROINTESTINAL BLEEDING
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78278 TC
|
| Hospital Charge Code |
3417827801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$206.10
|
| Rate for Payer: Aetna Government |
$206.10
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$512.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$431.05
|
| Rate for Payer: EmblemHealth Commercial |
$280.51
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$280.51
|
| Rate for Payer: Healthfirst Essential Plan |
$525.44
|
| Rate for Payer: United Healthcare Commercial |
$191.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$233.53
|
|
|
HC ACUTE MYELOID LEUKEMIA PANEL
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
3108145001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.00
|
|
|
HC ACUTE MYELOID LEUKEMIA PANEL
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
3108145001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$188.10 |
| Max. Negotiated Rate |
$774.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$759.53
|
| Rate for Payer: Aetna Government |
$759.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$531.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$531.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$531.67
|
| Rate for Payer: Brighton Health Commercial |
$759.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$759.53
|
| 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 |
$759.53
|
| Rate for Payer: EmblemHealth Commercial |
$759.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$683.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$645.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$675.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$759.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$675.98
|
| Rate for Payer: Group Health Inc Commercial |
$759.53
|
| Rate for Payer: Group Health Inc Medicare |
$759.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$759.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$759.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$759.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$759.53
|
| Rate for Payer: Healthfirst QHP |
$759.53
|
| Rate for Payer: Humana Medicare |
$774.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$759.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$759.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$759.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$721.55
|
| Rate for Payer: Wellcare Medicare |
$683.58
|
|
|
HC ADD WALKER TO PREV APPLIED CAST
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 29440
|
| Hospital Charge Code |
5102944001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$337.00 |
| Max. Negotiated Rate |
$337.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
|
|
HC ADD WALKER TO PREV APPLIED CAST
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 29440
|
| Hospital Charge Code |
5102944001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| 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 |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| 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 |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$183.15
|
|
|
HC ADENOVIRUS, ANTIBODY - ADENOVIRUS ANTIBODIES
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
3028660301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC ADENOVIRUS, ANTIBODY - ADENOVIRUS ANTIBODIES
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
3028660301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.87
|
| Rate for Payer: Aetna Government |
$12.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.01
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.87
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.87
|
| Rate for Payer: Group Health Inc Medicare |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$12.87
|
| Rate for Payer: Humana Medicare |
$13.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$16.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
|
|
HC ADENOVIRUS VACCINE TYPE 4 LIVE ORAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 90476
|
| Hospital Charge Code |
6369047601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.50
|
|
|
HC ADENOVIRUS VACCINE TYPE 4 LIVE ORAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 90476
|
| Hospital Charge Code |
6369047601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.15 |
| Max. Negotiated Rate |
$357.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$158.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.50
|
| Rate for Payer: Aetna Government |
$144.50
|
| Rate for Payer: Brighton Health Commercial |
$173.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.18
|
| Rate for Payer: EmblemHealth Commercial |
$144.50
|
| Rate for Payer: Group Health Inc Commercial |
$144.50
|
| Rate for Payer: Group Health Inc Medicare |
$101.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.50
|
| Rate for Payer: United Healthcare Commercial |
$357.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.85
|
|
|
HC ADMIN HEPATITIS B VACCINE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
771G001001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.46
|
| Rate for Payer: Brighton Health Commercial |
$86.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.17
|
| 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 |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$56.37
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.55
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC ADMIN HEPATITIS B VACCINE
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT G0010
|
| Hospital Charge Code |
771G001001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC ADMIN INFLUENZA VIRUS VAC
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
771G000801
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC ADMIN INFLUENZA VIRUS VAC
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
771G000801
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.36
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Brighton Health Commercial |
$86.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$30.06
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$13.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| 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 |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,336.00
|
| Rate for Payer: Healthfirst Essential Plan |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$21.78
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$30.06
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$30.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$14.70
|
| Rate for Payer: United Healthcare Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC ADMIN PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
771G000901
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.36
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Brighton Health Commercial |
$86.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$30.06
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$13.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| 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 |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,336.00
|
| Rate for Payer: Healthfirst Essential Plan |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$21.78
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$30.06
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$30.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$14.70
|
| Rate for Payer: United Healthcare Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
