|
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
|
|
|
HC ADVANCE CARE PLAN IN RCRD
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 1157F
|
| Hospital Charge Code |
9691157F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC ADVANCE CARE PLAN IN RCRD
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 1157F
|
| Hospital Charge Code |
9691157F01
|
|
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 ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
5109949801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
5109949801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Government |
$54.56
|
| 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 |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.48
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
5109949701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.00
|
|
|
HC ADVANCE CARE PLANNING FIRST 30 MINS
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
5109949701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.11 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.02
|
| Rate for Payer: Aetna Government |
$113.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$79.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$79.11
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.02
|
| 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 |
$113.02
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.59
|
| 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 |
$113.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.07
|
| Rate for Payer: Healthfirst QHP |
$113.02
|
| Rate for Payer: Humana Medicare |
$115.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.02
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$107.37
|
| Rate for Payer: Wellcare Medicare |
$107.37
|
|
|
HC ADVNC CARE PLAN TLK DOCD
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 1158F
|
| Hospital Charge Code |
9691158F01
|
|
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 ADVNC CARE PLAN TLK DOCD
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 1158F
|
| Hospital Charge Code |
9691158F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC AFTER CATARACT LASER SURGERY
|
Facility
|
IP
|
$1,535.00
|
|
|
Service Code
|
CPT 66821
|
| Hospital Charge Code |
5106682101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$767.50 |
| Max. Negotiated Rate |
$767.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.50
|
|
|
HC AFTER CATARACT LASER SURGERY
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
CPT 66821
|
| Hospital Charge Code |
5106682101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$670.29
|
| Rate for Payer: Aetna Government |
$670.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,536.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$682.93
|
| Rate for Payer: Amida Care Medicaid |
$682.93
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$670.29
|
| 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 |
$670.29
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$682.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$682.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,536.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,536.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$670.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$717.07
|
| 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 |
$682.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$294.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$682.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,536.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.75
|
| Rate for Payer: Healthfirst QHP |
$1,113.17
|
| Rate for Payer: Humana Medicare |
$683.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$703.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$682.93
|
| Rate for Payer: SOMOS Essential |
$1,536.59
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$751.21
|
| Rate for Payer: United Healthcare Medicaid |
$682.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$670.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$682.93
|
| Rate for Payer: Wellcare Medicare |
$636.78
|
|
|
HC AG DETECTION NOS, FLUOR
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87299
|
| Hospital Charge Code |
3068729901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC AG DETECTION NOS, FLUOR
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87299
|
| Hospital Charge Code |
3068729901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Government |
$16.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.27
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.10
|
| Rate for Payer: EmblemHealth Commercial |
$16.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.33
|
| Rate for Payer: Group Health Inc Commercial |
$16.10
|
| Rate for Payer: Group Health Inc Medicare |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.10
|
| Rate for Payer: Healthfirst QHP |
$16.10
|
| Rate for Payer: Humana Medicare |
$16.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.10
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.29
|
| Rate for Payer: Wellcare Medicare |
$14.49
|
|
|
HC AGENT NOS ASSAY W/OPTIC - CRYPTOCOCCUS ANTIGEN, CSF
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
3068789901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.07
|
| Rate for Payer: Aetna Government |
$16.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.25
|
| Rate for Payer: Brighton Health Commercial |
$30.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.07
|
| Rate for Payer: EmblemHealth Commercial |
$16.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.30
|
| Rate for Payer: Group Health Inc Commercial |
$16.07
|
| Rate for Payer: Group Health Inc Medicare |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.07
|
| Rate for Payer: Humana Medicare |
$16.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$14.46
|
|
|
HC AGENT NOS ASSAY W/OPTIC - CRYPTOCOCCUS ANTIGEN, CSF
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
3068789901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
|
|
HC AGGLUTININS; FEBRILE - FEBRILE AGGLUTININS
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
3028600001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.50
|
|
|
HC AGGLUTININS; FEBRILE - FEBRILE AGGLUTININS
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
3028600001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.98
|
| Rate for Payer: Aetna Government |
$6.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.89
|
| Rate for Payer: Brighton Health Commercial |
$20.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.98
|
| Rate for Payer: EmblemHealth Commercial |
$6.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.21
|
| Rate for Payer: Group Health Inc Commercial |
$6.98
|
| Rate for Payer: Group Health Inc Medicare |
$6.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.98
|
| Rate for Payer: Healthfirst QHP |
$6.98
|
| Rate for Payer: Humana Medicare |
$7.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.98
|
| Rate for Payer: United Healthcare Commercial |
$8.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.63
|
| Rate for Payer: Wellcare Medicare |
$6.28
|
|
|
HC AIR/CONTRAST INJECT INTO ABDOMEN
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 49400 TC
|
| Hospital Charge Code |
3614940001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.50 |
| Max. Negotiated Rate |
$252.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.50
|
|
|
HC AIR/CONTRAST INJECT INTO ABDOMEN
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 49400 TC
|
| Hospital Charge Code |
3614940001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.46 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$154.46
|
| Rate for Payer: Aetna Government |
$154.46
|
| Rate for Payer: Brighton Health Commercial |
$378.75
|
| 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 |
$252.50
|
| Rate for Payer: Group Health Inc Commercial |
$252.50
|
| Rate for Payer: Group Health Inc Medicare |
$176.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.50
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC ALBUMIN 25% 50ML INFUSION
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
636P904701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$85.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.45
|
| Rate for Payer: Aetna Government |
$52.45
|
| Rate for Payer: Brighton Health Commercial |
$78.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.33
|
| Rate for Payer: EmblemHealth Commercial |
$65.50
|
| Rate for Payer: Group Health Inc Commercial |
$65.50
|
| Rate for Payer: Group Health Inc Medicare |
$45.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.08
|
| Rate for Payer: United Healthcare Commercial |
$52.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.15
|
|
|
HC ALBUMIN 25% 50ML INFUSION
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT P9047
|
| Hospital Charge Code |
636P904701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.50 |
| Max. Negotiated Rate |
$65.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.50
|
|
|
HC ALBUMIN 5% 250ML INFUSION
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
636P904501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.50 |
| Max. Negotiated Rate |
$65.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.50
|
|
|
HC ALBUMIN 5% 250ML INFUSION
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT P9045
|
| Hospital Charge Code |
636P904501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.16 |
| Max. Negotiated Rate |
$86.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$53.08
|
| Rate for Payer: Aetna Government |
$53.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$37.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$37.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$37.16
|
| Rate for Payer: Brighton Health Commercial |
$78.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$53.08
|
| Rate for Payer: EmblemHealth Commercial |
$53.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.73
|
| Rate for Payer: Group Health Inc Commercial |
$53.08
|
| Rate for Payer: Group Health Inc Medicare |
$53.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.08
|
| Rate for Payer: Healthfirst Commercial |
$86.52
|
| Rate for Payer: Healthfirst Essential Plan |
$53.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.12
|
| Rate for Payer: Healthfirst QHP |
$53.08
|
| Rate for Payer: Humana Medicare |
$54.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.08
|
| Rate for Payer: United Healthcare Commercial |
$52.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.43
|
| Rate for Payer: Wellcare Medicare |
$50.43
|
|
|
HC ALCOHOL AND/OR DRUG ASSESSMENT
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT H0001
|
| Hospital Charge Code |
900H000101
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$466.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$99.45
|
| Rate for Payer: Aetna Government |
$99.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$466.83
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$466.83
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$207.48
|
| Rate for Payer: Amida Care Medicaid |
$207.48
|
| Rate for Payer: Brighton Health Commercial |
$337.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$207.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: EmblemHealth Commercial |
$225.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$466.83
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$207.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$466.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$466.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.85
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$207.48
|
| Rate for Payer: Healthfirst Essential Plan |
$466.83
|
| Rate for Payer: Healthfirst QHP |
$338.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$466.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$466.77
|
| Rate for Payer: Optum Medicaid |
$0.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$207.48
|
| Rate for Payer: SOMOS Essential |
$466.83
|
| Rate for Payer: United Healthcare Commercial |
$225.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$466.83
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$228.22
|
| Rate for Payer: United Healthcare Medicaid |
$207.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$207.48
|
|
|
HC ALCOHOL AND/OR DRUG ASSESSMENT
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT H0001
|
| Hospital Charge Code |
900H000101
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
|
